Note: The cases discussed in this post happened before COVID-19. Given that D-Dimer may be elevated in patients with COVID-19, the pretest probability of PE in your patient population may be elevated at this time. Thus, the assumptions derived from Kohn et al’s paper highlighted in this post may not Read more…
A 58-year-old male is rolled into the critical care area of your ED with the complaint of crushing, midsternal chest pain that began one hour before presentation. The nurse tells you he has a history of hypertension and hyperlipidemia but is currently not on any medications. You look at the Read more…
Last week’s post described the history of observation units, and how technology and knowledge has advanced since the early days of observation. Now, we are identifying more MIs in the ED and safely discharging a large swath of low-risk chest pain patients. So, who is left for observation? Are there Read more…
Accurate and expeditious diagnosis of acute myocardial infarction or acute coronary syndrome (ACS) is one of the key charges of emergency medicine providers. Chest pain is the second most common reason for emergency department visits in the United States and coronary artery disease is our leading cause of death (1,2). Read more…
February’s Food & Journal Club (FJC) article was chosen by one of the senior residents to open up a discussion regarding evaluation of chest pain in the ED and the utility of the HEART score in our patient population. The gracious Dr. Stetz hosted, the venerable Dr. Wiener presided, and Read more…
Thoracic Aortic Dissection A difficult to diagnose, uncommon, and potentially fatal condition: Emergency Medicine at its finest! Let’s talk about a patient we think see every day in the ED. A man comes in complaining of chest pain with elevated blood pressure of 200/90 upon triage. The ECG shows sinus Read more…
A 67 year-old male with history of hypertension, diabetes mellitus type II, dyslipidemia presents to the emergency department with 1 hour of severe chest discomfort that started while he was watching the evening news at home. The chest discomfort is substernal and radiates to his left shoulder and back. Review Read more…
An 83 year-old female comes to the ED with burning epigastric pain, worse with an empty stomach, non-radiating, and non-exertional. It is not associated with nausea, vomiting or diaphoresis. She has not tried any remedies at home, but nothing makes the pain better. You start delving into her medical history Read more…
58 year-old man presents with chest pain: 1) What is the diagnosis and management? 2) What is the patient’s prognosis?
Here is the EKG: The first interpretation would be to figure out the differential diagnosis for a regularly irregular rhythm in coupled beats. Without looking into more rare causes of coupled beats, the common causes includes atrial bigeminy, ventricular bigeminy, second degree AV block, and atrial flutter with variable conduction. Read more…