NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationHard
A 70-year-old male with a history of heart failure and recent surgery presents with sudden onset of severe shortness of breath, sharp chest pain that worsens with inspiration, and a feeling of impending doom. His SpO2 is 86% on room air, heart rate 110 bpm, and respiratory rate 30 breaths/min. Lung sounds are clear bilaterally. Which of the following is the most likely cause of his symptoms?
- AAcute exacerbation of heart failure.
- BPneumonia.
- CAcute myocardial infarction.
- DPulmonary embolism.
Show answer & explanationAnswer & explanation
Correct answer: D. Pulmonary embolism.
The sudden onset of severe dyspnea, sharp pleuritic chest pain, hypoxemia, tachycardia, and anxiety (feeling of impending doom), especially with a history of recent surgery (a risk factor for DVT/PE), strongly suggests a pulmonary embolism. Clear lung sounds help differentiate it from pneumonia or heart failure exacerbation.
Why the other options are wrong
- A. Acute heart failure exacerbation would typically present with crackles/rales due to pulmonary edema, which are not described here.
- B. Pneumonia typically presents with fever, cough with sputum, and often crackles/rhonchi on lung auscultation, which are absent here.
- C. While chest pain is present, the pleuritic nature and clear lung sounds make MI less likely than PE.
Pulmonary Embolism (PE) Presentation
A pulmonary embolism occurs when a blood clot blocks an artery in the lungs. Classic symptoms include sudden dyspnea, pleuritic chest pain, hypoxemia, tachycardia, and a sense of impending doom, often with clear lung sounds.
- Sudden onset dyspnea and pleuritic chest pain.
- Hypoxemia, tachycardia, anxiety.
- Common risk factors: recent surgery, immobility, DVT.
Memory trick: When 'SUDDEN' dyspnea and 'SHARP' pain hit, think 'PE', it's a 'PULMONARY EMERGENCY'.