karebear12892 Posted July 9, 2018 Share Posted July 9, 2018 Hi everyone! I'm about five months away from graduation and I've been browsing through case study posts for awhile now, but this is my first time posting one of my own, so please be gentle. 50 y/o AA male presented to rural ER via EMS w/ complaints of chest pain. EtOH on board. Given ASA and 1 NTG spray en route without relief. VS: HR 108, BP 110/65, RR 14, T 98.5, SpO2 99% Onset: "either 3 or 12 weeks ago" (intoxicated, no family present). Upon being asked what prompted him to seek emergency medical care today, he stated the pain had been significantly worse since he woke up this morning (saw him around 19:30). Unable to sensibly describe the quality of his pain Timing: constant Radiation: neck, jaw, both arms, back Aggravating Factors: deep inhalation, coughing, sneezing, decubitus positioning on either side Alleviating Factors: none, no medications at any point since onset of symptoms prior to EMS arrival Past medical history: none reported, no PCP, no daily medications Surgical history: non-contributory Social history: drinks liquor daily, freely admitted to consuming 1 pint of vodka earlier that day, smokes cigarettes daily, no illicit drug use reported ROS negative except for chest pain - no associated symptoms. PE (positive findings only): Clinically intoxicated, tearful. Appears thin. Tachycardic. Tenderness to palpation along sternum and anterior chest wall bilaterally. Pain is also reproducible with deep inhalation on lung exam. What's on your differential? What tests would you order? Ready, set, go! Quote Link to comment Share on other sites More sharing options...
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