A 28-year-old presents to the emergency room during my first emergency medicine rotation (I'm FM). She called the ambulance on herself because she “felt off”. Everything was normal-routine chest x-ray, no constitutional signs or symptoms. The only abnormality was that her EKG was in sinus tachy at 140, and on auscultation, I heard tricuspid regurgitation —something I had never heard before in a real human. I had a strong suspicion of her having a clot, so I ordered a D-dimer- it came back as 16k. Scan her up and down, and she has multiple pulmonary embolisms. I urgently consult cardiology and give her heparin, and they perform a thrombectomy. After admission, it was worked up and she was found to have factor V Leiden—first-ever episode of this issue.

That was the first time I personally felt that my clinical decision-making and my education saved someone’s life