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Shortness of Breath 

Shortness of Breath
Shortness of Breath
Acute Care Casebook

Harman S. Gill


Chest pain and dyspnea are complaints frequently associated with a diagnosis of pulmonary embolism but may also be associated with other numerous cardiac and pulmonary disease processes encountered daily in the emergency department. This case presents the classic historical risk factors of malignancy and recent surgery in combination with typical clinical findings of acute onset of chest pain and dyspnea that is worse with deep inspiration. A sequential and methodological assessment through a thorough physical exam, electrocardiogram, chest X-ray, and lab testing such as troponin, pro-brain natriuretic peptide, and D-dimer testing allow the emergency medicine practitioner to be accurate, thorough, and efficient. Once a diagnosis is made, the stratification of massive versus submassive is dictated by hemodynamic stability and the presence or absence of acute right ventricular strain to further guide treatment and disposition.

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