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.
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