A 45-year-old man is evaluated in the emergency department for acute shortness of breath with right-sided chest pain. He also has a dry cough with scanty blood streaking of his phlegm. He is a nonsmoker and has no other past medical illnesses; he has just returned by airplane from Japan.
On physical examination, his temperature is 37.4°C (99.4°F), blood pressure is 102/76 mm Hg, pulse rate is 98 beats per minute, and respiration is 32 breaths per minute. D-dimer is elevated. Creatinine is 0.5. Breath sounds are clear bilaterally. There are no rhonchi auscultated. He feels soreness in the left calf and has trace left ankle edema. All peripheral pulses are intact. What is your first step in treatment for this patient?

Question

Quizplus · Accepted Answer

The patient's symptoms and recent travel history suggest a pulmonary embolism. A CT angiogram of the chest is the appropriate first step to confirm the diagnosis.

A 45-Year-Old Man Is Evaluated in the Emergency Department for Acute