Determining the Cause

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

 

The ST Segment | ECG Basics - MedSchool

ST Segment Elevation

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

Pericardial Effusion

     
D-Dimer* Elevated, Greater than .05 < .05    

Stable Patient

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