A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
Figure 1. Index ECG.
A 68-year-old female with a past medical history of untreated hypertension was referred to the ED from an outside clinic for hypertension. She had been off antihypertensive medications for several months and had attempted to re-establish care with a PCP but was referred to the ED for a blood pressure of 200/120. At triage, she denied any symptoms. An ECG was obtained at 15:22, when the patient was asymptomatic.
Iris Lawson-Seebaran, DO
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Source: http://www.svuhradiology.ie/case-study/mediastinal-widening-cxr/
Picture the following encounter: A 52-year-old male presents with chest pain. He seems comfortable and is slightly hypertensive to 156/83, but the rest of his vital signs are normal. He admits to using cocaine prior to the onset of chest pain. He denies any radiation of pain or other associated symptoms. When you are going through your differential, you consider aortic dissection, and you wonder if there are any tools to help you decide if this patient should get a CT angiography (CTA) study to further evaluate for aortic dissection.
Taylor Wahrenbrock, MD and Kathryn McGregor, MD
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Figure 1. Point-of-care echocardiogram demonstrating the D-sign and a trace pericardial effusion.
The Case:
The patient is a 64-year-old female with an unknown past medical history who presented to the ED with altered mental status. Her BP was 100/80 mmHg, HR 101 BPM, RR 21 bpm, SPO2 63% on room air, and T 36.8ºC (98.3ºF). The patient was placed on a non-rebreather mask at 15L, and her oxygen saturation improved to 97%. She was given sedatives for acute agitation and delirium. On exam, the patient was tachypneic and had bilateral crackles and decreased breath sounds throughout all lung fields. Her cardiac exam was notable for a regular rhythm without murmur. The remainder of the physical exam was unremarkable.
Michael Hohl, MD
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