EM Case Files

Being the astute resident you are, you decide to perform a physical exam:

BP: 140/84   P: 56 reg     R: 30 labored     T: 100.8 ^oF     SpO₂: 97% on 2 LPM

HEENT:  NC/AT. PERRL @ 3 mm. Airway clear & self-maintained.

Neck: Supple. JVD noted.

Lungs: BS CTA bilaterally.

CV: Loud S1 heard with audible S3. Diastolic rumble heard. 

Abd: Soft, non-tender to palpation.

Ext: Active ROM x 4. Digital clubbing noted with distal cyanosis. No edema noted.

You now have narrowed your differential, what would you like to do next?