Triage: Chest pain since yesterday. Denies SOB or leg swelling
History of Present Illness: A woman in her mid 60’s presents to the ER with 24 hours of pain that started between her shoulder blades bilaterally then migrated to her left chest.
Vital Signs: T: 37.0 °C, HR: 80, RR: 17, BP: 114/72, SpO2: 98%
Physical Exam: Physical exam is normal including no rales or wheezing with deep inspiration and no murmur with halted respirations
Initial Diagnostic Testing:
- Imaging: POCUS Video – CLICK HERE TO WATCH
What is the diagnosis?
- A) Cervical radiculopathy
- B) Aortic dissection
- C) Cardiac tamponade
- D) None of the above
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
<<<<<<<<<<<<<<<<<<<<< ADVERTISEMENT & SPACER >>>>>>>>>>>>>>>>>>>>>
THE EMERGENCY MEDICINE POCKETBOOK TRIFECTA
- Emergency Medicine 1-Minute Consult, 5th edition
- A-to-Z EM Pharmacopoeia & Antibiotic Guide, 5th edition
- 8-in-1 Emergency Department Quick Reference, 5th edition
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What is the most likely diagnosis?
- A) Cervical radiculopathy – a common cause of intrascapular pain and can even cause chest pain but both should be UNILATERAL
- B) Aortic dissection – CORRECT – Always consider with bilateral intrascapular pain. BP in the other arm was NOT normal. It was 193/122
- C) Cardiac tamponade – not present, YET, but the main cause of death with aortic dissection so look for a pericardial effusion during chest pain POCUS
- D) None of the above
1-Minute Consult on this topic: Click HERE and scroll to proper page
CASE CONCLUSION: went to OR with thoracic surgery for type A aortic dissection
CASE LESSONS: POCUS can expedite the diagnosis in many diseases. Know which ones they are