Chief Complaint: Chest Pain
Note: Even in the stable patient, immediate life threatening conditions must be diagnosed
Pivotal Assessments (One after the other) | Finding | ||||||
---|---|---|---|---|---|---|---|
EKG
|
Non ST Segment Elevation | Indeterminate | Left bundle branch block | Presence of Q waves | T-wave inversion | Normal | |
Portable Chest X-Ray | Pneumothorax | Pneumonia | White opacity with obliteration of the costophrenic angle | Widened mediastinum (>8.0-8.8 cm at the level of the aortic knob) wide aortic contour, tracheal deviation, aortic kinking, and displacement of previous aortic calcification. Chest x-ray has limited sensitivity (64%) and specificity (86%) in the diagnosis of aortic diseases. It also worth mentioning that a normal chest x-ray may not rule out the diagnosis of aortic dissection. |
Normal | ||
Echocardiogram | |||||||
D-Dimer* | Elevated, Greater than .05 | < .05 |