Author: Jason M Kendall / Editor: Jason M Kendall / Reviewer: Michael Perry, Muhammad Waseem / Codes: CC5, CC7, CP1, RP7, SLO1, SLO4 / Published: 04/12/2022
A 67-year-old man is brought into the emergency department (ED) with collapse associated with chest pain.
He has a history of hypertension and has had a previous myocardial infarction. He takes ramipril, atenolol, aspirin and simvastatin.
On examination he is in marked pain, and is pale and clammy. His observations are as follows: P = 105, BP = 90/50, SaO2 = 92% on 15 litres O2, RR = 25, Temperature = 35.8 degrees centigrade. His JVP is elevated. His heart sounds are quiet and there is a diastolic murmur. Chest auscultation reveals some bilateral basal crackles.
His ECG shows a sinus tachycardia with minimal inferior ST segment depression.
His CXR is as shown:
You suspect that this patient is suffering from an acute aortic dissection.
Module Content
Chest Pain Syndromes
Chest pain is caused by a spectrum of pathology ranging from the innocent to the extremely serious.
Shock
The relative incidence and mortality of shock varies greatly depending on the population and the cause.
Abdominal and Cardiothoracic Evaluation with Sonography in Shock (ACES)
This session covers ACES scans which can provide crucial information in undifferentiated shocked patients.
26 Comments
Good and commo case
excellent case presentation
The case is giving variations of dd of these kind of presentations and if I have it next time I would check O2 saturation if not improving it may be a case of massive PE . and definitely I wouldn’t put pericardiocentesis in that patient.
Good one
A very concise and relevant module in Aortic aneurysms
excellent case discussion
Good Case
Well articulated, easy to follow and great learning points!
Good learning points regarding aortic dissection. I learned that pericardiocentsis is not advised in these kinds of patient unless prearrest
Good case and learning points
Excellent reading about sudden collapse with chest pain.
Typical A&E scenario
Very concise and relevant module
very precise
Good Information
Excellent reading
interesting , good learning points
Excellent read
Good learning points
Interesting case
Good case
excellent discussion
interesting case, thanks
Great
V good module
This case is very enlightening highlighting the salient features of acute aortic dissection, the relevant investigations, and the appropriate emergency management and specialty that should offer definitive care