امرأة عمرها ٤٥ سنة دخلت بجلطة الأوردة العميقة وتأخذ علاجها منذ يومين. فجأة صار عندها ضيق نفس وألم صدري حاد يزيد مع الشهيق، وقلق شديد. النبض ١٢٤، والتنفس ٣٠، والتشبع ٨٨٪، والضغط ١٠٨/٧٠. ما أول إجراء؟

A 45-year-old woman admitted with DVT has been on treatment for two days. Suddenly she has breathlessness, sharp chest pain worse on inspiration and marked anxiety. HR 124, RR 30, SpO2 88%, BP 108/70. What is the first action?

1. Sit her up, give oxygen and call for help
2. Lay her flat and raise her legs
3. Massage her leg to improve venous flow
4. Give sublingual nitroglycerin for the pain

Answer: A) Sit her up, give oxygen and call for help. The sudden symptoms suggest pulmonary embolism. Breathing comes first: sit up, oxygen and the rapid response team, then diagnosis and anticoagulation or thrombolysis by severity.