For decades, Emergency Medicine Providers have struggled to come to a consensus on the management of patients with chest pain with non-ischemic ECGs and negative biomarker testing. Both cardiology and emergency medicine guidelines failed to provide a clear recommendation on which patients should be discharged from the ED. The American College of Emergency Physicians has taken a bold step with their latest guidelines for the management of low risk chest pain patients which will dramatically change standard practice in the care of possible ACS patients.
A 28-year old male with no past medical history presents with ches tpain for 2 days. The pain is pressure-like in the center of his ches tand worse with deep inspiration. He states he just got over a cold but denies recent fever or cough. An EKG is obtained. What is the diagnosis?
While the scuba diving decompression illnesses of decompression sickness and arterial gas embolism are treated the same, the pathophysiology and presentation are different.
A 60-year-old man presents with chest pain. His EKG shows ST elevations in leads II, III and aVF as well as ST depressions in V2 and V3. A right-sided electrocardiogram is also performed and shows elevated ST segments in V4R and V5R. Which of the following medications is contraindicated?
A 40 year old male with history of Marfan's Syndrome comes in with sudden onset shortness of breath preceded by tearing chest pain. He is tachycardic to 120, blood pressure is 80/40, patient is tachypneic with increased work of breathing. CXR is consistent with widened mediastinum and pulmonary edema and stat bedside ECHO is concerning for acute aortic regurgitation secondary to aortic insufficiency. Cardiothoracic surgery is consulted. What two medical modalities are contraindicated in this patient?
A. Beta Blocker and Intra-Aortic Balloon Pump
68yo Male, hx DM (+insulin pump), CHF (+lasix), HTN, presents to the ED c/o intermittent episodes of lightheadedness for the past year, becoming more frequent over the past month and had an episode today while getting out of bed. No syncope. At home noted HR 33, went to urgent care, HR 37. Patient was sent to the ED for further evaluation. What did the ECG show?