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EM Case Files

A 62 y/o female presents with a 2 month history of worsening dyspnea.  She had been treated with 2 courses of antibiotics for bronchitis/pneumonia without relief.  She was seen in an Urgent Care Center earlier in the day where her D-Dimer was found to be markedly elevated.  She was referred to our facility for a CT of the Chest to R/O Pulmonary Embolism. You enter the room and notice an elderly female with moderate, 3-4 word dyspnea. The nurse has established oxygen via a Nasal Cannula at 2 LPM, IV access and continuous ECG monitoring. 

The patient reports some dyspnea on exertion with fatigue and dizziness. Her ROS reveals fever, weight loss, arthralgias and pain to her fingertips when exposed to cold. She reports her fingers first become pale, then purple and after a while they become painful and red.

What's the next appropriate step?