22nd June 2023

A 61-year-old lady with a background of metastatic breast cancer with known bony, hepatic and pulmonary metastases

A 61-year-old lady with a background of metastatic breast cancer with known bony, hepatic and pulmonary metastases, currently taking oral capecitabine chemotherapy tablets, presents to the emergency department with acute on chronic back pain and a ‘band-like’ pain around her chest. She has no other significant past medical history. She appears clammy, sweaty, and grey. Observations are: HR: 94 BP: 88/50 SATS 96% on air, RR: 24 and T: 36.4C.

What is the next most important investigation?