Case 1

An 81-year-old lady patient who lives alone, attends your ED with a 3-day history of a painful, swollen right lower leg.

She has been sleeping in her chair as she has been unable to get upstairs due to the pain. She feels unwell and has not been eating for the last two days. She has a history of a right deep vein thrombosis seven years ago after a myocardial infarction, and has longstanding mild chronic renal impairment, (creatinine 172).

On examination, she is apyrexial. Her right leg is red, warm, tender, and swollen.