Janice Muller

A 55-year-old woman on day 4 post-surgery presents with sudden onset right-sided pleuritic chest pain and breathlessness over the past 2 hours. She has been immobile since the operation and received a blood transfusion. Take a focused history, perform a targeted examination, order urgent investigations, and formulate an emergency management plan.

1. 1Take a focused history of the chest pain and breathlessness using SOCRATES
2. 2Identify and systematically assess all PE risk factors (immobility, surgery, prior DVT/PE, OCP)
3. 3Screen for and exclude other acute cardiorespiratory diagnoses
4. 4Verbalise a targeted cardiorespiratory examination
5. 5Apply the Wells clinical decision rule and justify investigation choices
6. 6Order urgent investigations including D-dimer, CTPA, ABG and ECG
7. 7State a working diagnosis with relevant differentials and risk stratification
8. 8Initiate anticoagulation, oxygen and monitoring; arrange high-dependency care