60 yo M, unrestrained driver in MVA, no airbags, no LOC, no head trauma, complaining of chest pain – midline, reproducible to palpation, worse on moving.
VS 120, 96/47, 22, 100%
Trauma labs are sent, portable CXR and Pelvis Xray are unremarkable.
Let’s say his hypothetical pan-scan is normal.
What dangerous, life-threatening condition could he have that has yet to be assessed?
How is this disease diagnosed?
1. ECG – if normal, very unlikely cardiac contusion, but disease can manifest in many different ways: sinus tach, RBBB, 1st degree block, scattered ST depressions, dysrhythmias.
2. Troponin I – Very specific, poor sensitivity. Do not use CK after trauma.
3. Echo- can show wall-motion abnormalities. Can also be used to check for tampanode or ventricular rupture
Dispo?
By Dr. Andrew Grock and Dr Sally Bogoch
References
Current Diagnosis and Treatment in Emergency Medicine 7th edition, C. Keith Stone, Roger L. Humphries. Also Harrison’s, Tintanalli’s,
andygrock
- Resident Editor In Chief of blog.clinicalmonster.com.
- Co-Founder and Co-Director of the ALiEM AIR Executive Board - Check it out here: http://www.aliem.com/aliem-approved-instructional-resources-air-series/
- Resident at Kings County Hospital
Latest posts by andygrock (see all)
- A Tox Mystery…. - May 26, 2015
- Of Course, US Only for Kidney Stones… - May 18, 2015
- Case of the Month 11: Answer - May 12, 2015
- Too Classic a Question to Be Bored Review - May 5, 2015
- Case of the Month 11: Presentation - May 1, 2015