65.A 71-year-old woman presents to the ED after a reported mechanical
fall 2 days ago. Her initial vitals include a HR of 55 beats per minute, a BP
of 110/60 mm Hg, an RR of 14 breaths per minute, and an oxygen satura-
tion of 96% on room air. The patient does not appear to be taking deep
breaths. Her physical examination is significant for decreased breath
sounds bilaterally and tenderness to palpation along the right side of her
chest. After initial stabilization, which of the following is the diagnostic test
of choice for this patient’s condition?
a. Chest x-ray
b. Chest CT scan
c. ECG
d. Rib radiographs
e. Thoracentesis
66.A 29-year-old woman presents to the ED for hyperventilation. Her initial
vitals include an RR of 28 breaths per minute with an oxygen saturation of
100% on room air. She is able to speak in full sentences and tells you that she
cannot breathe and that her hands and feet are cramping up. She denies any
trauma, past medical history, or illicit drug use. Chest auscultation reveals
clear breath sounds bilaterally. A subsequent chest radiograph is normal.
Upon reevaluation, the patient reports that she is breathing better. Her vitals
include an RR of 12 breaths per minute with an oxygen saturation of 100% on
room air. Which of the following conditions is most likely the etiology of this
patient’s symptoms?
a. Pneumothorax
b. Hemopneumothorax
c. Pleural effusion
d. Anxiety attack
e. Asthma exacerbation
58 Emergency Medicine