 You're working in the emergency department today. Your next patient is a 55-year-old female who comes in because of chest pain and shortness of breath. Her triage vitals include the following. Heart rate of 115, blood pressure of 120 over 80, rest rate of 24, oxygen of 88% in remair. Her temperature is 37. She is now put on and monitored bed. The patient is given oxygen by your nurse. Her saturation goes up to 94% on four liters. She is also attached to the cardiac monitors. Your nurse also calls for a 12-lead ECG. You now interview the patient. She says that her chest pain started three days ago. It was gradual onset. The pain is sharp and she rates it as a 7 out of 10. It is made worse when she takes a breath in. The pain does not radiate anywhere else. The only associated symptoms is shortness of breath. She feels that she cannot take a big breath. Her pain is mostly in the front and the right side of her chest. The patient has no infectious symptoms or risk factors. She has no fever, cough, sputum production or sick contacts. For ACS, the patient has no risk factors for ACS. The pain is not worse with exertion and is not better at rest. Besides shortness of breath, she has no associated symptoms. The patient's pain does not start from the back. It is not sudden in onset and there is no history for hypertension, making it less likely for aortic dissection. There has been no previous history of trauma or fall and there has been no history of spontaneous pneumothorax in the patient. On further history, the patient states that 4 days ago she came back from a 12-hour flight. She is also on a hormone replacement therapy for menopausal symptoms. On examination, she is still tachycardic, tachypnic and hypoxic on room air. The patient looks uncomfortable. Her cardiac exam is normal. For a breast exam, you are unable to hear good breath sounds because she is on a bed to take a big breath. The rest of her examination is normal, including no signs of DVT in the legs. Your nurse now brings you the ECG. It shows sinus tachycardia and flipped T's in the interior leads. There are no other abnormalities. You call for a chest x-ray. It shows no collapse lung and no infiltrate. There are some atlactases at the base. You discuss this case with your staff. After your discussion, you decided the patient is at high risk of having a pulmonary embolism. You ordered some routine blood work, a troponence, and you send the patient over for a CT scan of the chest. The CT chest shows that the patient has a pulmonary embolism in the right middle and right lower lobe. The patient's blood work comes back normal. You started the patient on one dose of low molecular weight heparin. Since she is hypoxic, she needed to be admitted to the hospital. You discuss with the on-call team for further management of this patient.