Tuesday afternoon I admitted a patient who had fallen at home. The herdmans had found the patient, called EMS, and brought to our ED. The only real complaint was shortness of breath. After a workup and refusal to be transferred to a cardiologist, the patient came to me. The only complaints were shortness of breath and 8/10 pain LUQ midclav line with tenderness to light palpation. Exam showed bibas crackles, HR of ~125, warm face, cool extremities, and abrasion L knee. Rest was normal.
The images show a rhythm strip, 12 lead EKG, and XRay.
What do you think?
Troponin was 1.65. D-Dimer was 0.30 - 0.60.
As the evening wore on urine output went to 10ml/h. RR ~30 and slightly labored. SpO2 was 97% with nonrebreather mask, and pain. Pain was controlled with morphine 2mg IV. I don't expect the patient to last 24 hours.
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