Case 1

 

18 y/o male patient that comes to ED due to chest pain of 2 weeks of evolution, worst when laying upright, pressure sharp, with subjective fever and shortness of breath.

 

Pt states that was seen in the ED one week prior,due to  flu like symptoms (fever, cough and nasal congestion) followed by chest pain. Currently, pt states being afebrile, with chest pain 7/10 with shortness of breath, worst in supine position and with improvement when leaning forward. 

 

PE: Temp 98.1 F, HR 92 RR 20 BP 109/60 Sat 100%

 

GEN: Mild to moderate distress.

HEENT: Dry oral mucosa, No JVD

CHEST: Regular rhythm, no murmurs, no gallops, clear to auscultation bilateral

ABD: Bowel sounds present, no tenderness

Ext: No edema or cyanosis

Neuro: No gross deficits. 

EKG

CXR

D-dimer = 7.66

What next?

Bedside ECHO