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Look through the information provided in this case study and highlight all of the information that might concern you as a paramedic.

1  List your differential diagnoses for this patient. Musculoskeletal pain.Pericarditis.Hyperventilation.Chest infection.Syncope.Pneumothorax.

2  List as many predisposing factors associated with PE as you can. Which could assist you with working through your differential diagnosis and history taking? See Table 1.2.Table 1.2 Pulmonary embolism predisposing factorsSource: JRCALC (2019), p. 367.Surgery, especially recent Abdominal Pelvic Hip or knee Post‐operative intensive careObstetrics PregnancyCardiac Recent acute myocardial infarctionLimb problems Recent lower limb fractures Varicose veins Lower limb problems secondary to stroke or spinal cord injuryMalignancy Abdominal and /or pelvic, in particular advanced metastatic disease Concurrent chemotherapyOther Risk increases with age >60 years of age Previous proven deep vein thrombosis (DVT)/PE Immobility Thrombotic disorder Neurological disease with extremity paresis Thrombophilia Hormone replacement therapy and oral contraception Prolonged bed rest >3 days Other recent trauma

1  What validated assessment tool could assist you with assessing the probability of PE in this patient? See Table 1.3.Table 1.3 Wells’ criteria for PESource: JRCALC (2019), p. 368.CriteriaScoreClinical signs and symptoms of DVT (leg swelling and pain with palpation of the deep veins)3An alternative diagnosis is PE is less likely3Pulse rate >100 bpm1.5Immobilisation or surgery in the previous 4 weeks1.5Previous DVT/PE1.5Haemoptysis1Malignancy (treatment ongoing or within the last 6 months or palliative)1Clinical probabilityHigh>6 pointsModerate2–6 pointsLow<2 pointsNote: When using the Wells’ criteria, a low probability does not rule out PE.