Professional Documents
Culture Documents
You are an intern at GCUH and you have been told by your registrar to see Janet, aged 65,
who has just been triaged by the nurse. She has presenting because of new onset chest
pain.
Task
Take relevant histories and perform relevant physical exam on Janet. Report back to your
registrar and include an assessment and your recommendations.
SP information
Presenting complaint
Central chest pain
Social history
Ex-smoker (20 pack years)
Social drinker
No recreational drugs
Works as a retired high school teacher
Physical exam
BP 130/80 HR 130 RR 34 T37.6 SaO2 94%RA
Tachypnea and tachycardia
Decreased breath sounds on auscultation
Raised JVP
L) leg erythematous evident on inspection
Investigations
Baseline bloods
o FBC, Chem20, ESR, CRP
o ABG
Confirm/exclude diagnosis
o PERC score can be used to exclude PE clinically without any tests in certain
patients
o D-dimer if low PE wells score
o CTPA (or v/q if contraindicated)
Investigate severity
o ECG (tachycardia, RV strain i.e. t-wave inversion in right precordial and
inferior leads. RBBB, RAD, S1Q3T3)
o CXR (wedge infarcts, regional oligaemia, enlarged pulmonary artery, effusion)
o Echocardiogram
o Bilateral leg doppler
Management