Chest Pain – Clot or Bleeding?

Author: Jonathan M Jones / Editor: Jonathan M Jones / Reviewer: Michael Perry / Codes: ResC10, ResP1, ResP2, SLO1, SLO3 / Published: 09/07/2022

A previously well 36-year-old woman presents with intrascapular back pain. The pain had been intermittent yesterday but today is more severe and associated with two episodes of pre-syncope. She is somewhat short of breath.

On examination she looks pale and unwell with a blood pressure in the left arm of 85/63 and in the right of 107/77 (the ambulance crew recorded a BP of 70 systolic at the scene). HR 127 (regular), Sats 100% on non-rebreathing mask with 15l.min O2. Temp 37.5

Chest clear to auscultation with bilateral equal air entry. Abdomen soft and non-tender. No leg pain or swelling. Neurological examination intact.

No recent long distance travel and no family history of note.

No medication. Her ECG and CXR are as shown:

Her ABG (on O2 as above) shows:

pO2 36.71, pCO2 4.11, pH 7.41

Following 1 litre of fluid her blood pressure in the left arm has increased to around 110 systolic. Her heart rate is now 120.