Sharp Chest Pain Scenario

What is this patient’s NEWS score?

You are concerned about the patients lower than normal SpO2. For a range between 93-94%, what level of O2 device can you use to assist SpO2 levels?

Further history shows that this pain came on suddenly whilst watching TV, and immediately after the patient felt he was finding it hard to catch his breath at rest. This occurred approximately 45 minutes ago.  He has had a dry cough over the last 2-3 days. Deep inhalation increases his pain. The pain is focal to the right side of the chest and non-radiating. His pain score is still 8/10 NPS. You try to do further assessments however the patient is very unsettled and is unable keep still. You need to get his pain under control quickly so you can continue your patient assessment? 

In this scenario, what pain relief would you deem appropriate? 

You gain IV access and give Paracetamol and Morphine. The pain settles and patient is calmer so you complete an ECG. This is your ECG… 

What is your interpretation? 

You are concerned about a Pulmonary embolism as the patient is tachycardic, has pleuritic sounding chest pain and you see leads V1-5 have inverted T waves. What does the inverted T waves in this ECG usually represent?

There are many ECG findings associated with PE diagnosis. Out of the following, what are the 3 most common findings?

How often would you see the classic S1, Q3, T3 sign in an ECG of a patient with a PE diagnosis?

As you explore your PE diagnosis further, what clinical tool can help in your assessment?

As suggested in the Wells score assessment, you look at the patient’s lower legs for clinical signs of DVT (deep vein thrombosis). What are the signs you are looking for? TICK ALL THAT APPLY

Even though you are confident on your PE differential, you asses the patient’s chest. What would you likely hear on auscultation when suspecting an acute PE diagnosis?

This patient can be managed in a primary care setting as your treatment has stabilised them sufficiently and they will more than likely require anti-coagulants that can be prescribed by a GP?

What risk factors are associated with PE? TICK ALL THAT APPLY

If using the Wells score, if the patient is scored as low probability, you can then exclude your PE differential?

If haemodynamic instability does occur in a patient with a diagnosis of PE, what kind of shock is this categorised as?

The type and severity of signs and symptoms a patient with PE will exhibit will be dependent on the size of the thrombus? 

What is the percentage of mortality associated with PE?