***DISCHARGE

Emergency department chest pain evaluation was completed which included a 12-lead EKG, serial troponins, a chest x-ray, and laboratory studies.  The patient’s chest pain {IS/IS NOT:9024} concerning for {Blank multiple:19196::”pulmonary embolus”,”cardiac ischemia”, “aortic dissection”,”***”}, as evidenced by {Blank multiple:19196::”the quality of the pain”,”ECG findings”, “***”}. Given the extremely low risk of these diagnoses further testing and evaluation for these possibilities does not appear to be indicated at this time. 

The patient’s chest x-ray was within normal limits making significant pneumothorax, pneumonia, lung abscess, or aortic pathology much less likely. The patient’s EKG does not show changes consistent with pericarditis. The patient’s symptomatology and physical exam are not completely consistent with myocarditis, costochondritis, pleurisy, aortic pathology or pulmonary embolus.

The patient understands that at this time there is no evidence for a more malignant underlying process, but the patient also understands that early in the process of an illness or injury, an emergency department workup can be falsely reassuring.  Routine discharge counseling was given, and the patient understands that worsening, changing or persistent symptoms should prompt an immediate call or follow up with their primary physician or return to the emergency department. The importance of appropriate follow up was also discussed. More extensive discharge instructions were given in the patient’s discharge paperwork.

***ADMIT

Emergency department chest pain evaluation was completed which included a 12-lead EKG, serial troponins, a chest x-ray, and laboratory studies.  The patient’s chest pain {IS/IS NOT:9024} concerning for {Blank multiple:19196::”pulmonary embolus”,”cardiac ischemia”, “aortic dissection”,”***”}, as evidenced by {Blank multiple:19196::”the quality of the pain”,”ECG findings”, “***”}. Given the risks associated with this etiology,  further testing and evaluation is warranted so the patient will be brought into the hospital under the {admit service:60658} service and {admit service:60658} will be consulted. 

The patient’s chest x-ray was within normal limits making significant pneumothorax, pneumonia, lung abscess, or aortic pathology much less likely. The patient’s EKG does not show changes consistent with pericarditis. The patient’s symptomatology and physical exam are not completely consistent with myocarditis, costochondritis, pleurisy, aortic pathology or pulmonary embolus.

*** STEMI

EKG:  NSR with a rate of ***, normal axis, normal conduction, with ST and T waves showing ***.  

Impression: *** ST Elevation Myocardial Infarction.  

Timing of events:  

***  Initial EKG

***  EKG seen by attending physician

***  STEMI Alert called

***  Cardiologist paged

***  Cardiologist returned call

***  Patient to Cath Lab

OLD RECORDS REVIEWED:

Previous ECG: {Time; dates multiple:15870} reviewed and demonstrates {Blank single:19197::”no changes”, “ischemic changes”, “non-specific changes”,”***”}

@LASTPROC(ekg)@

@RESUFAST(EKG1)@

Old Cath: {Time; dates multiple:15870} reviewed and revealed {Blank single:19197::”that no interventions were performed”, “minimal disease without progression”, “significant disease with the need for intervention”,”***”}

@LASTIMG(cath01)@

Old ECHO: {Time; dates multiple:15870} reviewed and was found to be {Blank single:19197::”concerning for worsening disease”, “concerning for new disease”, “insignificant for progressive disease”,”***”}

@LASTIMG(ech10)@

@LASTIMG(ech11)@