His background history: healthy, previous asthma (now quiescent), hyperlipidemia on treatment, and a 1/2 pack per day smoker. NO known cardiac history, no other risk factors, and generally feeling at his usual state of health until today.
He woke up with a vague central chest ache without radiation, which gradually increased in intensity over the subsequent hours, becoming increasingly uncomfortable when he moved, breathed or coughed. The pain never really let up and acetaminophen did not relieve it. The pain was worst when he lay supine.
He came into the hospital because he was in agony, with diaphoresis but no shortness of breath.
Questions:
1. How would you assess him further - what are the immediate assessments and subsequent steps? What other information would you require?
2. What is the differential diagnosis at this point?
3. What are the priorities in his management? What would you embark upon now and what would you wait to do?
4. How can you Confirm what is going on?
5. What possible Causes are you looking for?
6. What possible Complications are you looking for?
7. What will be your plans after your initial evaluation?
Here is an ECG that was done.
Work through the above questions, make comments below, and then check back for some teaching tips....
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