Authors: Yvette Ruddock  / Editor: Steve Corry-Bass / Codes: CP1, GP9, SLO3, SuP7 / Published: 15/11/2018

A previously fit and well 59-year-old man presented complaining of severe chest pain. He had consumed some alcohol which was unusual for him. On coming home, he had had multiple vomits. The last was particularly forceful. It was after this he experienced lower central chest pain described as severe which morphine had not settled.

On examination he looked unwell with pallor and was clammy. He had a mild tachypnoea; other observations were in the normal range. On palpation of his anterior chest wall crepitus was felt. His ECG appeared normal.

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