A 35-year-old woman on oral contraceptive pills presents with pleuritic chest pain and tachypnea. She has no past medical history. Her blood pressure and oxygen saturation are normal. What should be the next step in management?
This patient's use of oral contraceptive pills, which are known to be a risk factor for venous thromboembolism, along with her symptoms of pleuritic chest pain and tachypnea, make pulmonary embolism a possible diagnosis. The first step would be to estimate the pre-test probability using a validated clinical decision rule such as the Wells score or the Geneva score. If the score suggests a low probability, a D-dimer test can be used to rule out the diagnosis. If the score suggests a high probability, proceed directly to imaging with CT pulmonary angiography.