Your patient is a 24-year-old male who has been an in-patient in a rehabilitation hospital following surgical fixation of a fractured pelvis. Staff reports sudden development of hypotension and severe respiratory distress about 30 minutes ago. There is no other significant history. Physical exam findings include cold, diaphoretic skin with peripheral cyanosis; jugular venous distension; clear breath sounds bilaterally; and vitals as follows: HR = 134, BP = 74/50, RR = 28, SaO₂ = 84%. Which of the following is most likely?

Question

Quizplus · Accepted Answer

The sudden onset of hypotension and severe respiratory distress in a young patient with no significant medical history is highly suggestive of a pulmonary embolism. The presence of jugular venous distension and peripheral cyanosis suggest right heart strain due to a large clot obstructing blood flow from the pulmonary artery. The tachycardia and tachypnea are likely compensatory mechanisms trying to maintain oxygenation. A spontaneous tension pneumothorax would present with unilateral chest pain and asymmetrical lung sounds, while myocardial infarction and idiopathic congestive heart failure would not cause sudden respiratory distress.

Your Patient Is a 24-Year-Old Male Who Has Been an In-Patient