Case Report A Patient with Suspected Pulmonary Embolism Urgent message: High degree of suspicion combined with thorough history and proper use of available tests can help the clinician iden- tify patients in need of emergent referral. John Shufeldt, MD, JD, MBA, FACEP and Kelli Hickle 47-year-old woman with a diagnosis of ovarian cancer developed an acute onset of mild shortness of breath two days after being discharged for a work-up of sympto- matic ascites. Her medical history was significant for obesity and recent travel. She presented to the emergency department and was found to have a large left pleural ef- fusion and was subsequently admitted to the hospital. A thoracentesis performed in the ED removed 2 L of fluid. During her hospital stay, her respiratory status im- proved and she was discharged home. Two days later, she presented to an urgent care with the complaint of dyspnea. A chest x-ray was performed to rule out a pneumothorax from the thoracentesis or a reaccumulation of the effusion. The chest ray was neg- ative for both. She was given albuterol in a small-volume nebulizer, improved post-treatment, and was sent home. At discharge, she was afebrile, with a room air pulse oxime- try of 92%, pulse of 110 beats per minute, and respira- tory rate of 24. A w w w. j u c m . c o m The following day, she be- came dyspneic and cyanotic and complained of chest pain with hemoptysis. After a 911 call, she was taken to the emergency department where she arrested moments after arrival. Her resuscita- tion was unsuccessful. An autopsy revealed a large sad- dle embolus and acute cor pulmonale. Her family sued the urgent care center, the physician, the hospital, and the emer- gency department attending for wrongful death second- ary to failure to diagnose pul- monary embolism. This article reviews the etiology, di- agnosis, and treatment for pulmonary embolism (PE) in an urgent care setting. © imagesMD.com Introduction Pulmonary Embolism: An Overview Pulmonary embolism is a remarkably common—and of- ten underappreciated—leading cause of death in all age groups. In the U.S., roughly 60,000 people die per year from pulmonary embolism 1 ; many of these cases are di- agnosed at autopsy. Pulmonary embolism and deep venous thrombosis JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | M a rc h 2 0 0 9 19