A 33-Year-Old Postpartum Woman Is Brought to the Emergency Department

question 1675

Multiple Choice

A 33-year-old postpartum woman is brought to the emergency department with sudden onset of severe dyspnea and right-sided chest pain that began 3 hours ago when getting up from breastfeeding her child.  The patient was discharged from the hospital 4 days ago after an uneventful elective cesarean delivery.  She does not use tobacco, alcohol, or illicit drugs.  Temperature is 36.7 C (98 F) , blood pressure is 100/70 mm Hg, pulse is 128/min, and respirations are 32/min.  Pulse oximetry is 84% on room air.  BMI is 34 kg/m².  Examination shows a woman in moderate respiratory distress with evidence of accessory muscle use.  She is alert and cooperative, without cyanosis or jaundice.  Heart sounds are normal.  The chest is clear to auscultation.  Chest x-ray reveals no infiltrates and heart size is normal.  ECG shows sinus tachycardia.  Arterial blood gas analysis results are as follows: In addition to supplemental oxygen therapy, which of the following is the best initial step in management of this patient?

• A)CT angiogram of the chest
• B)D-dimer testing
• C)Intravenous heparin infusion
• D)Lower extremity venous ultrasound
• E)Transthoracic echocardiogram
• F)Troponin and CK-MB testing

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Definitions:

Somatic Nervous System

A part of the peripheral nervous system responsible for carrying motor and sensory information both to and from the central nervous system.

Peripheral Nervous System

A portion of the nervous system that consists of the nerves outside the brain and spinal cord, connecting the central nervous system to limbs and organs.

Autonomic Nervous System

The part of the nervous system responsible for control of bodily functions not consciously directed, such as breathing, the heartbeat, and digestive processes.

Sensory Neurons

Nerve cells responsible for converting external stimuli from the organism's environment into internal electrical impulses.