Broken CT Scanner… December 1, 2013
Posted by Andy Jagoda, MD in: Cardiovascular , trackback
The next week, you are working at a free-standing ED where the patients are checking in at record volume. You are getting pressure to see and discharge patients as fast as possible when you see a 21-year-old male presenting with chest pain radiating to his back, along with some shortness of breath. The patient reports no improvement in symptoms with over-the-counter analgesics. The patient plays on the local varsity basketball team. He has no known medical history, and his social history is negative for tobacco, alcohol, or illicit drugs. He appears slightly anxious and has a blood pressure of 155/90 mm Hg and a heart rate of 95 beats/min. He is tall and thin and has reproducible chest tenderness. Your CT scanner has unexpectedly gone down and is unavailable for the rest of the night. ECG shows a normal sinus rhythm without evidence of ischemia and a plain chest radiograph appears normal. As you start to watch your department getting backed up, the nurse states that he is concerned about this patient. You assess the patient as low risk for pulmonary embolism, so you decide to get a D-dimer, which comes back negative. You wonder if this patient has something more significant and what your diagnostic options are…
Knowing the CT scanner is down, what steps could you take?
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