84 years old female is brought by ambulance with history of shortness of breath. On arrival, she is unable to talk in full sentences, but does complain of pain in the right chest. She is unable to take deep breaths while you ask her during auscultation. In her past medical history, she has HTN, DM, and multiple myeloma. Recently she was discharged after staying in the hospital for 7 days following a mechanical fall. She lives in a care home and rarely is seen out of her bed. She is on Flucloxacillin for her right leg cellulitis, apart from her routine medications. Her observations at triage are BP 100/80, Pulse 125/min, RR 19/min, Temperature 98.2F SpO2 on room air 82%

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As per ECG as Dr.Hilal has rightly suggested,pul.embolism should be suspected and looked for.But patient is having many comorbidities so she should be looked for CRF,electrolytes, diabetic status.Septicaemia should be taken care of as she is having cellulitis.Good antibiotics cover is required.Should get c/s if discharge in some wound is there.Needs in hospital care.

ECG - -RBBB , Go for 2decho , CXR , and CT-PA ,D-Dimer , to rule out Pulmonary embolism .and colour Doppler of the affected limb to rule out DVT.

S1Q3T3 sign..case of PE ..

S1Q3 T3 pattern – deep S wave in lead I, Q wave in III, inverted T wave in III. This “classic” finding is neither sensitive nor specific for pulmonary embolism; found in only 20% of patients with PE.
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RBBB S1Q3T3 Clinical pt is very suspicious for PE & ecg findings (although not very specific ) But in investigation P.E is on top

Pulmonary embolism

Bed ridden, chest pain,low spo2,tachycardia,apyrexial, ECG showing s1 q3 t3 ,)rbbb .1st diagnosis is pulmonary embolism.Spiral CT chest is recommended Bed ridden

RBBB with PE

ECG -sinus techycardia. VPC are seen. Bifesicular block RBBB.WITH LPHB. Left Axis. More interesting is Pt. have multiple myeloma. Due to it have more possibility to devlope pneumonia .so she may have it.and devlope brethlessnes & techycardia and techypoenia

RBBB , PE. 2D echo? D-dimer?

Other routine CBC,LFT,RFT,PT,APTT,XRAY ,CT,HBA1C,A.B.G
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Pulmonary embolism

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