then ask ...
LIQORAAA.....DDX MI , dissecting aneurysm ,pul.embolisom ,esophgeal spasm
..ask around these things
imp aspects ..PMH , SH , FH ...
IX ..ECG , CXR , TEE..
55yo M c/o pressure like 9/10 ,sudden onset , incresinf left saided achest pain that stared 2 hr ago. it radiates to the left arm & jaw,not relieved by any thing & is associated with Nausea & SOB with sweating .he repotrs having same episodes of paib in the past yr ,once ot twice every week but they are less sever , burning in quality & related to heavy food , cold drinks & sex.no chang oin bowel or urniry habbits
ROS -ve , PMH /hpt for 10 yrs /MI 2years ago /medication ACE-I,atenolol ,lovastatin, aspirin ,psh -ve ,NKDA,FH,-ve,SH smokes 1ppdfor 11yrs , no drinking ,eats junk food ,no exercise ,sexually active with wife.
pt in acute distress,alert , orientes *3
neck do the thyriod , JVP , carotids
chest full examinayion back & front
abdomen look & listen
legs check edema & pulses
..tell your impression
DDX ..what IX will order .. DDX ..& Ix as above
then concel for smoking ,,I'm afraid that you hav dangerous habbit in your life ..you need to quit smoking .
then ask if any QQ
then thank .. say bye