NREMT Emergency Medical Technician (EMT) Cognitive ExamCardiology & ResuscitationHard
A 28-year-old female presents with sudden onset of severe shortness of breath, sharp chest pain that worsens with inhalation, and a feeling of impending doom. She recently took a long-haul flight. Her vital signs are: BP 100/60 mmHg, HR 120 bpm, RR 30 breaths/min, SpO2 88% on room air. Lung sounds are clear bilaterally. What is the MOST likely cause of her symptoms?
- AAsthma Exacerbation
- BPulmonary Embolism (PE)
- CSpontaneous Pneumothorax
- DAcute Myocardial Infarction (AMI)
Show answer & explanationAnswer & explanation
Correct answer: B. Pulmonary Embolism (PE)
The patient's acute presentation of sudden severe shortness of breath, pleuritic chest pain, tachycardia, hypoxia (SpO2 88%), and a risk factor of recent long-haul flight (increasing risk of deep vein thrombosis and subsequent PE) are highly indicative of a pulmonary embolism. Clear lung sounds often differentiate PE from other respiratory causes.
Why the other options are wrong
- A. Asthma exacerbation would typically present with wheezing and often a history of asthma, which are not present here. Lung sounds are clear.
- C. Spontaneous pneumothorax would present with sudden pleuritic pain and dyspnea, but typically with diminished or absent lung sounds on the affected side, and often in tall, thin males.
- D. AMI typically presents with crushing, substernal pain, not typically pleuritic, and usually without a prominent recent flight history as a direct cause.
Pulmonary Embolism (PE) Recognition
Pulmonary embolism is a life-threatening blockage of a pulmonary artery, often presenting with sudden dyspnea, pleuritic chest pain, tachycardia, and hypoxemia, often with risk factors like recent immobility.
- Sudden onset of symptoms is common.
- Risk factors include recent surgery, immobility (long flights), birth control.
- Can be difficult to diagnose prehospital, requiring high suspicion.
Memory trick: Short of breath, chest pain sharp, after a long trip – think 'PE is a deadly trap!'