NREMT Paramedic Cognitive ExamAirway, Respiration & VentilationHard
A 70-year-old female presents with acute onset of severe shortness of breath, anxiety, and a sudden sharp chest pain that worsens with inspiration. She has a history of recent knee surgery and is currently taking oral contraceptives. Her SpO2 is 89% on room air, heart rate is 110 bpm, respiratory rate is 28 breaths/min, and blood pressure is 130/80 mmHg. Lung sounds are clear bilaterally. What is the most likely cause of her symptoms?
- AAcute myocardial infarction (AMI).
- BPulmonary embolism (PE).
- CSpontaneous pneumothorax.
- DPneumonia.
Show answer & explanationAnswer & explanation
Correct answer: B. Pulmonary embolism (PE).
This patient's presentation with sudden onset dyspnea, pleuritic chest pain, hypoxemia, tachycardia, and risk factors (recent surgery, oral contraceptives) is highly suggestive of a pulmonary embolism. The clear lung sounds also help rule out pneumonia or significant pneumothorax.
Why the other options are wrong
- A. While chest pain and dyspnea can occur, AMI pain is typically crushing/squeezing, often radiating, and less commonly pleuritic. Risk factors for AMI are different.
- C. Spontaneous pneumothorax would typically present with sudden pleuritic chest pain and dyspnea, but often with diminished or absent lung sounds on one side, not clear bilaterally. Her risk factors also point away from spontaneous pneumothorax.
- D. Pneumonia usually presents with fever, productive cough, and localized crackles/rhonchi on auscultation, which are absent here.
Pulmonary Embolism (PE) Presentation
A sudden blockage in a pulmonary artery, often by a blood clot from a deep vein thrombosis (DVT), presenting with abrupt dyspnea, pleuritic chest pain, and hypoxemia.
- Risk factors: recent surgery, immobility, oral contraceptives, cancer.
- Symptoms: sudden dyspnea, pleuritic chest pain, tachycardia, hypoxemia.
- Management: oxygen, pain management, rapid transport for definitive treatment.
Memory trick: STAT for Chest Pain! Severity, Type, Associated, Triggers.