50 Emergency Medicine
47.A 45-year-old woman presents to the ED immediately after landing at
the airport from a transatlantic flight. She states that a few moments after
landing she felt short of breath and felt pain in her chest when she took a
deep breath. Her only medications are oral contraceptive pills and levothy-
roxine. She is a social drinker and smokes cigarettes occasionally. Her BP is
130/75 mm Hg, HR is 98 beats per minute, temperature is 98.9°F, RR is
20 breaths per minute, and oxygen saturation is 97% on room air. You
send her for a duplex ultrasound of her legs, which is positive for deep vein
thrombosis. What is the most appropriate management for this patient?
a. Place patient on a monitor, provide supplemental oxygen, and administer
unfractionated heparin.
b. Place patient on a monitor, order a chest computed tomography (CT) scan to
confirm a pulmonary embolism (PE), and then administer unfractionated
heparin.
c. Place patient on a monitor and administer aspirin.
d. Instruct the patient to walk around the ED so that she remains mobile and does
not exacerbate thrombus formation.
e. Place the patient on a monitor, provide supplemental oxygen, and administer
warfarin.
48.A 54-year-old undomiciled woman presents to the ED with severe
cough, general malaise, and subjective fevers for the last week. She also
describes coughing up “chicken livers” during this time and reports that
her symptoms are getting progressively worse. Her initial vitals include a
HR of 100 beats per minute, a BP of 145/66 mm Hg, temperature of 99.9°F,
and an RR of 16 breaths per minute with an oxygen saturation of 95% on
room air. She states that she has a history of alcohol abuse, but denies tak-
ing any medications or illicit drugs. A chest radiograph shows a lobar pneu-
monia. Given this patient’s clinical presentation, which of the following is
this patient at most risk for contracting?
a. Streptococcus pneumoniae
b. Klebsiella pneumoniae
c. Mycoplasma pneumoniae
d. Legionella pneumophila
e. Haemophilus influenzae