MVC_ChestPain

alt-save:

ED COURSE, DISCUSSION & MEDICAL DECISION MAKING:

-Motor vehicle collision
– DDx. Given nature of presenting complaint (CC), pt was evaluated emergently for the following to determine if need for emergent diagnostics/interventions. When upon my eval, the hx/exam was exceeding clear that more emergent morbid/mortal pathologies were not in any reasonable refined ddx to this pt's presentation, further work up was not unnecessarily pursued to prevent putting pt at – in my professional opinion – were not indicated risks and outweighed benefit.  Guidance was by consideration and appreciation for pt's best interest. 
     Myocardial contusion, rib fracture, pulmonary contusion,
– A/P:
– ED Course:
     Chest x-ray shows no evidence of rib fracture, no radiopacity concerning for pulmonary contusion
– Diagnostically: (aspects of evaluation emphasized given significant contribution to MDM):
     Chest x-ray, EKG, troponin all do not show any evidence of ischemia thereby making myocardial contusion less likely.  Patient has no shortness of breath and no pulmonary symptoms therefore pneumonia and pulmonary contusion unlikely.  There is no point tenderness over ribs therefore unlikely rib fracture. Given concordance of time of pain with MVC, suspect related and hx/exam/evala and not //w ACS and 
– Therapeutically: 
     NSAIDs
– Diagnosis:
    Ecchymosis
–     (most consistent with dx above wth understanding for diagnostic limitations due to emergent setting of encounter)
 
– Dispo:
    Home with PMD follow-up

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