Stage 1 — Recognize cues. Read the ED admission note. Highli… | MyMerci
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Medical Emergencies

Stage 1 — Recognize cues. Read the ED admission note. Highlight every finding that most directly increases concern for an acute pulmonary embolism or immediate cardiopulmonary compromise.

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A 65-year-old male is postoperative day 7 after right total knee arthroplasty. History includes controlled hypertension, type 2 diabetes, and hyperlipidemia managed with prescribed outpatient medications and a 30 pack-year smoking history reported during intake. Prescribed prophylactic enoxaparin was interrupted 2 days ago when the medication supply ran out. Family brought him to the ED for sudden sharp right-sided chest pain that worsens with inspiration and shortness of breath. Assessment shows BP 92/58, HR 124, RR 28, and SpO2 88 percent on room air, temperature 36.7 C with no recent fever or chills, and diaphoresis with anxiety while accompanied by family. He denies prior cardiac symptoms before this event. The right calf is mildly tender without visible swelling.
A 65-year-old male is postoperative day 7 after right total knee arthroplasty. History includes controlled hypertension, type 2 diabetes, and hyperlipidemia managed with prescribed outpatient medications and a 30 pack-year smoking history reported during intake. Prescribed prophylactic enoxaparin was interrupted 2 days ago when the medication supply ran out. Family brought him to the ED for sudden sharp right-sided chest pain that worsens with inspiration and shortness of breath. Assessment shows BP 92/58, HR 124, RR 28, and SpO2 88 percent on room air, temperature 36.7 C with no recent fever or chills, and diaphoresis with anxiety while accompanied by family. He denies prior cardiac symptoms before this event. The right calf is mildly tender without visible swelling.
Explanation
Five high-priority cues
The strongest linked cues are recent total knee arthroplasty; interruption of prescribed thromboprophylaxis; sudden pleuritic chest pain with dyspnea; hypotension, tachycardia, tachypnea, and hypoxemia; and unilateral calf tenderness. Together they connect a recent venous-thromboembolism risk state, a possible deep-vein source, and acute cardiopulmonary compromise. Chronic conditions and smoking history matter to overall risk but are not the most direct cues in this acute pattern.
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