A 52-year-old male with a recent history of knee surgery is brought to the emergency department with acute onset of sharp chest pain, difficulty breathing, and coughing up blood. Vital signs include respiratory rate of 22 breaths per minute, heart rate of 110 beats per minute, and oxygen saturation of 89% on room air. His rhythm strip shows a regular tachycardia without specific ST or T wave changes. Which diagnostic test is most likely to confirm the suspected condition?
Given the patient's symptoms of sharp chest pain, respiratory distress, and hemoptysis, combined with risk factors such as recent surgery, a computed tomography pulmonary angiography (CTPA) is warranted to confirm the suspicion of a pulmonary embolus as it provides a direct visualization of the blood vessels in the lungs and can identify a clot if present. A D-dimer test can help in ruling out the condition in a patient with a low pretest probability, but it is not confirmatory. An electrocardiogram can show signs suggestive of pulmonary embolism but is not diagnostic, especially if the changes are not specific. A chest X-ray cannot confirm a pulmonary embolism as it may only reveal indirect signs or be completely normal.
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Respiratory Emergencies
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