Scribe BC - ED admission note
Chief Complaint
- Presenting Issue: Chest pain.
- The patient presents with sudden onset of severe chest pain, radiating to the left arm, associated with shortness of breath and diaphoresis.
Past Medical History
- Hypertension, Hyperlipidemia.
- Appendectomy at age 16.
- Medications: Aspirin 81mg daily, Atorvastatin 20mg daily, Lisinopril 10mg daily.
- Allergies: NKDA.
Social History
- Smokes 1 pack of cigarettes per day for 20 years.
- Drinks alcohol occasionally, 2-3 units per week.
- Denies illicit drug use.
- Works as a software engineer.
Family History
- Father had a history of myocardial infarction at age 60.
Physical Examination
- Vital Signs: BP 160/90 mmHg, HR 110 bpm, RR 24 breaths/min, Temp 37.0°C, SpO2 94% on room air.
- General examination: Appears anxious and in moderate distress.
- CVS: Tachycardic, regular rhythm, no murmurs.
- Resp: Bilateral crackles in the lower lung fields.
- Abdo: Soft, non-tender, bowel sounds present.
- MSK: No deformities or limitations.
- Neuro: Alert and oriented to person, place, and time.
Investigations
- Pathology: Troponin elevated, CBC within normal limits, electrolytes WNL.
- Imaging: Chest X-ray shows mild pulmonary congestion. ECG shows ST-segment elevation in leads II, III, and aVF.
- Other Investigations: None.
Assessment
- Acute Myocardial Infarction (Inferior wall).
- Differential diagnosis: Unstable angina, pulmonary embolism, aortic dissection.
Plan/Treatment
- Immediate Management: Administered 325mg aspirin, 0.4mg sublingual nitroglycerin, and started on oxygen. IV access established.
- Investigations: Cardiac catheterization planned.
- Referrals: Cardiology consult requested.
- Discharge & Follow-up Instructions: Patient to be admitted to the cardiac care unit. Follow-up with cardiologist scheduled within one week.
Emergency
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