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here's a pt i saw while out in the boonies doing more than i should probably have been allowed. i'm curious as to how you approach cc's of cp in young patients with no risk factors.
17 yo hispanic male presents to ED with 1 hour hx of sudden onset "stabbing, constant" left sided chest pain from the margin of his sternum ~t4-t6 extending into his left axilla. no tachypenia/tachycardia, O2 sat 99%. lungs BCTA, heart RRR no murmurs. breathing unlabored but deep breaths do aggrivate pain. all vitals nl. was playing video games at onset of pain which is rating at 7-8/10. pain not reproducable w/palpation. movement of extremeties/torso does not aggrivate pain. no trauma hx. ROS unremarkable for anything (including sx of respiratory infection). reports having drunk 1.5 2-liter bottles of mt. dew in hours preceding onset.
medical hx postive for mild asthma which is currently not being treated.
CXR nl.
did not get an ekg or work this up furthur. called it pluritic chest pain and tx'ed as such. (attending agreed, signed the chart and sent the kiddo home).
i'm wondering if you guys think an ekg would have been in order? my feeling was obviously no (as was my attendings) but the nurses would not shut up about wanting to get one. did we skip a simple and relatively inexpensive tests that we probably shouldn't have? if this kid walked into your ED instead of the 3 pt/day ED in the middle of nowhere would you have worked him up differently?
and more generally, how much do you let your index of suspicion down (in terms of cardiac origin) for chest pain in young people with no other risk factors? does chest pain = chest pain = chest pain w/ the same sx in a patient who is 15, 20, 25, or 30?
and i know it's kind of a general question, so sorry about that.
dave
17 yo hispanic male presents to ED with 1 hour hx of sudden onset "stabbing, constant" left sided chest pain from the margin of his sternum ~t4-t6 extending into his left axilla. no tachypenia/tachycardia, O2 sat 99%. lungs BCTA, heart RRR no murmurs. breathing unlabored but deep breaths do aggrivate pain. all vitals nl. was playing video games at onset of pain which is rating at 7-8/10. pain not reproducable w/palpation. movement of extremeties/torso does not aggrivate pain. no trauma hx. ROS unremarkable for anything (including sx of respiratory infection). reports having drunk 1.5 2-liter bottles of mt. dew in hours preceding onset.
medical hx postive for mild asthma which is currently not being treated.
CXR nl.
did not get an ekg or work this up furthur. called it pluritic chest pain and tx'ed as such. (attending agreed, signed the chart and sent the kiddo home).
i'm wondering if you guys think an ekg would have been in order? my feeling was obviously no (as was my attendings) but the nurses would not shut up about wanting to get one. did we skip a simple and relatively inexpensive tests that we probably shouldn't have? if this kid walked into your ED instead of the 3 pt/day ED in the middle of nowhere would you have worked him up differently?
and more generally, how much do you let your index of suspicion down (in terms of cardiac origin) for chest pain in young people with no other risk factors? does chest pain = chest pain = chest pain w/ the same sx in a patient who is 15, 20, 25, or 30?
and i know it's kind of a general question, so sorry about that.
dave