Crushing chest pain in a 58-year-old man
Emergency Department Resuscitation BayArthur Pendelton · 58yo male · CC: Crushing chest pressure and sweating
History
0/5 key findingsAsk the questions your differential demands — not just the ones the case volunteers. Every diagnosis you intend to list owes you one discriminating question.
CASE SETTING: EMERGENCY DEPARTMENT RESUSCITATION BAY
Arthur Pendelton, a 58-year-old man with substernal chest pressure, hypotension, elevated JVP, and clear lungs
Vitals
Opening
Arthur Pendelton, a 58-year-old high school principal, is brought in by EMS with 75 minutes of crushing substernal chest pressure, nausea, and profuse sweating that began while shoveling his driveway. He is pale and diaphoretic with a blood pressure of 88/54 mmHg and a heart rate of 52 bpm.
Triage note
58-year-old male with 75 minutes of 9/10 substernal pressure radiating to the jaw and epigastrium, diaphoresis, and one episode of emesis. BP 88/54, HR 52, SpO₂ 96% RA.
From the patient
"It started 75 minutes ago while shoveling snow—like an elephant sitting on the center of my chest, going up into my jaw and pit of my stomach. I broke out in a cold sweat and threw up in the driveway."
Arthur Pendelton · 58yo male
Pale, diaphoretic man clutching his sternum on the resuscitation gurney, with visibly distended neck veins