Back Again!

Author: Madeleine Taylor, Joanne Ollerton / Editor: Sarah Edwards / Codes: ResC10, ResP2, ResP3, SLO1 / Published: 18/05/2026

A 32-year-old female presents to the Emergency Department (ED) after recommendation from the General Practitioner (GP) due to ongoing right upper back pain and worsening shortness of breath. The GP also provided a course Cefalexin antibiotics.

She is assessed in the ED before being transferred to Same Day Emergency Care (SDEC).

The patient reports a cold 2 weeks ago, followed by 5 days of worsening shortness of breath, with right upper back pain starting yesterday. She reports a cough with blood-streaked sputum, without fever or other signs of infection. The pain is localised to the right upper back, non-radiating, rated 6/10 and worse on deep inspiration. No other chest pain is present. She is short of breath at rest.

Past medical history includes ulcerative colitis with J-tube placement, endometriosis with her ovaries and fallopian tubes removed, primary sclerosing cholangitis and asthma.

The patient is currently on HRT, has a penicillin allergy, and has previously used immunosuppressants for UC.

Examination:

• Respiratory examination: No added breath sounds, talking in full sentences but sounds breathless.
• Cardiovascular examination: Mild tachycardia, normal heart sounds.
• Abdominal examination: SNT
• Calves: SNT
• No focal neurological deficit on gross inspection.

Initial observations:

• NEWS=1
• Temp 36.6’c, O2 on air 97%, BP 133/89, HR 109, RR 18.
• D-dimer is raised at 760, cardiac troponin 1 normal.
• Other bloods are unremarkable.
• ECG shows tachycardia and no other findings.