Chief Complaint
- 35 year old African-American woman presents to Emergency Department with coughing up blood
HPI
- Has been coughing up moderate amounts of blood with clots over the past 3 hours
- Has associated shortness of breath
- Associated lower extremity swelling noticed over the past week
- Denies fevers, chest pain, dizziness, lightheadedness, or any prior episodes
PMH
- No significant past medical history
Family History
- Father with hypertension on amlodipine
- Mother with COPD
Social History
- No smoking or illicit drug use
- Social alcohol consumption
- Lifelong midwestern United States resident
- No history of incarceration or homelessness
Vitals
Temp: 37.4° C, BP: 98/52 mmHg, HR: 112 bpm, RR: 24 rpm, SpO2: 84% on room air
Physical Exam
- Alert, oriented, moderate distress with frequent coughing with occasional blood-streaked sputum and blood clots
- Diffuse, wet crackles auscultated throughout posterior lung fields
- Increased work of breathing with use of accessory muscles
- Heart rate tachycardic, normal in rhythm without murmurs
- Abdomen soft, nontender, nondistended
- 3+ pitting edema in bilateral lower extremities
What would you do next for this patient?
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