Cardiovascular Heart sounds irregular with no murmur good S1 and S2 no S3 or S4

Cardiovascular heart sounds irregular with no murmur

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Cardiovascular — Heart sounds irregular with no murmur, good S1 and S2, no S3 or S4 Abdomen — Protuberant with normoactive bowel sounds x 4 quadrants Peripheral Vascular — Right calf with 2+ edema, erythema; warmth and tenderness on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally Diagnostic tests : 1. CT Pulmonary Angiogram (CTPA): Is a fast and reliable method to diagnose the presence of a pulmonary embolism (PE) and is the diagnostic test of choice (Albrecht, et al., 2017). 2. Transthoracic Echocardiogram: Can determine the presence of acute cor pulmonale from a large pulmonary embolism but may not show any abnormality if it is small (Misiaszek & Budhram, 2009). This is a great test to determine the size of the pulmonary embolism by the effect on the heart as well as the need for treatment. 3. EKG: Findings can show signs of acute cor pulmonale and is present in 15% to 25% of patients with pulmonary embolism (Levis, 2011) 4. Ultrasound Lower Extremities: 80-90% of patients with a PE have or had a DVT in the lower extremities and about 50% of DVT will become PEs (Dwyer, Rempell, & Stone, 2018). 5. D-dimer: Less specific test that is hard to determine the likelihood of PE and PE should be considered when the level is four times its normal in patients without a cancer history, age less than 65 years, and no recent pregnancy or surgery (Sikora-Skrabaka, et al., 2019). 6. Troponins: Can help determine the severity of the PE as elevations usually mean there is heart strain or ischemia (Kilinc, et al., 2012).
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7. V/Q scan: Greater variability and non-diagnostic in about 25% of patients, and should be
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