Diagnose It Answer — April 1, 2026
ALL CLUES
62-year-old female presents with sudden onset shortness of breath and sharp chest pain that worsens with deep breathing.
Patient returned from a 14-hour international flight 3 days ago. No prior cardiac history. Recently started hormone replacement therapy (HRT).
HR 118, RR 24, O₂ sat 88% on room air, BP 104/68, temp 37.4°C. Patient appears anxious and diaphoretic.
Unilateral right leg swelling and tenderness noted. Calf circumference 3cm greater on right than left. Homans' sign positive.
D-dimer markedly elevated at 4.2 µg/mL FEU (normal <0.50). ECG shows sinus tachycardia with S1Q3T3 pattern. CXR shows Hampton's hump.
Pulmonary embolism occurs when a blood clot lodges in a pulmonary artery, obstructing blood flow to the lungs. Risk factors include immobility, hypercoagulable states, and estrogen use. Nurses must assess for tachycardia, hypoxia, and unilateral leg swelling — a D-dimer above 0.50 µg/mL FEU combined with these findings is critical and demands emergent CT pulmonary angiography. Rapid recognition and anticoagulation are essential to preventing hemodynamic collapse and mortality.
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