Author: Tim Osborne / Editor: Sarah Edwards / Reviewer: Tim Osbourne / Codes: CC1, CC2, CP1, CP2, RP7, SLO1, SLO2, SLO3 / Published: 15/11/2021
An 84-year-old man presents to the Emergency Department at midday with severe chest pain and breathlessness and is moved immediately to the resuscitation room.
The pain has started around 8 hours earlier and gradually worsened. He feels dizzy and has nearly collapsed at home. For the previous month he has been getting chest pain on minimal exertion. There is no history of leg swelling or orthopnoea.
He has a past medical history of hypertension for which he takes ramipril. There is no other relevant medical or surgical history.
On examination he is distressed and in pain. He looks extremely unwell. His peripheries are cool and mottled. You cannot palpate a radial pulse. You cannot visualise the JVP. Heart sounds are quiet but you do not hear any murmurs. His respiratory rate is elevated and there are bi-basal crepitations. There is no limb swelling or pitting oedema.
Initial observations:
- Temp 37.4
- HR 98
- BP 68/43
- RR 28
- O2 not reading reliably
Shortly afterwards the patient goes into a PEA cardiac arrest.
11 responses
very informative article
Interesting learning
good
interseting
Interesting case
Very informative. RBBB with hypotension can also be secondary to massive PE. It would be challenging to differentiate between ACS and PE in this case. With new knowledge acquired through this module i.e. new RBBB (with bifascicular block) equates to occlusion of LAD, I feel in a better position to convince on call cardiologist for PCI in the middle of the night (day time is no problem as they can review patient in ED)
Interesting case
Interesting indeed.
Excellent
Thought it PE from first instance
Great Revision