PE, Chest Pain, Asthma/RAD, ?

[RocketMedic]

47 y/o F cc tachypnic dyspnea, new-onset chest pain 10/10 sharp, stabbing point pain to right chest approx at v1, radiating straight to back, changing with breathing, x1 hour. Short of breath, gradually intensifying, x2 days. Diminished tidal volume, wheezes and rhonchi in all lung fields. P90 sinus rhythm, BP 155/105, capno consistent with air trapping/40, SpO2 100% room air, skin pale warm dry. History of asthma, massive PE, diabetes. Compliant with most meds, on warfarin. Reports prior "heart trouble" as well. 300 pounds.
I thought PE, called med control, asked what they thought, since RAD exacerbation was also high on my list. They ordered 1 nitro trial (no effect) and a neb treatment, which I BiPapd in with patient relief of tachypnea and increase in tidal volume, partial resolution of wheezes. Chest pain unresolved, unchanged. Er said that she was most likely a RAD exacerbation with very possible PE.

 

[FLdoc2011]

Common things being common, and since she has history of it...probably asthma exacc.
Does she use inhalers at home? Has she recently been having to use rescue inhaler more frequently? Does she test her own peak flows?

Is she currently on coumadin? You know what her INR was in ER? Or what her last INR was?

She might have a PE, but is she's on Coumadin and therapeutic then she's already being treated and not much else to do there.

 

[RocketMedic]

Common things being common, and since she has history of it...probably asthma exacc.
Does she use inhalers at home? Has she recently been having to use rescue inhaler more frequently? Does she test her own peak flows?

Is she currently on coumadin? You know what her INR was in ER? Or what her last INR was?

She might have a PE, but is she's on Coumadin and therapeutic then she's already being treated and not much else to do there.

Rescue inhaler use has been more common since PE. INR was low, not sure on values, but it wasnt remarkable. Coumadin levels were really low. I was thinking asthma exacerbation and/or PE, not really cardiac.