Story of a Chest Pain Patient

So I had an interesting experience that I wanted to share. Scary for me actually, but it's a good teaching point.

Two nights ago my mom called me. I knew she'd been having some angina in the past week, off and on, and I (and everyone else) had been trying to get her to see a doctor, but good luck with that. So she calls me Thursday night and says "Last night I had jaw pain, and suddenly today I'm feeling nauseous and freezing and the chest pain is really increasing, it's lasting longer". When asked what the pain feels like she reported that it is a "pressure", a dull pain that is not severe, but definitely not comfortable (was impossible to get #/10). For some background, she's a 55y/o female with no significant family hx for any disease or disorder other than that her father died of colon cancer; she also takes a baby aspirin QD, and has not changed any medications recently.

Finally I convinced her that it was worth going at least to Urgent Care to get it figured out. Her boyfriend drove her, and by the time they got there he says she was faint and almost passed out. The Urgent Care providers did an EKG-- normal. But based on her sx they were very concerned of the possibility of an MI still, and sent her by ambulance to the hospital.

At the hospital they did another EKG-- normal again. Her vital signs were all normal except for temp which was 100.5 (barely even considered a temp). They drew blood for CPK and Troponin levels, and also took an x-ray. She had absolutely no other symptoms- negative GI, negative pulm, negative HEENT, etc. They also gave her pain medication because her chest pain was still intense.

So at this point I'm thinking MI, anxiety, flu, pulmonary embolism, pericarditis, etc, none of which seemed to fit exactly. So here's what I thought was the surprising part- she was diagnosed with lingular pneumonia. What?!?! Ok. So the lingula of the left lobe is just under the heart, and apparently when she pointed to where it hurt the doc said, "Yup, that's it". No real fever, no cough, nothing to signal pneumonia. But I thought it was an interesting teaching moment, at least for me, because it was so easy to think of heart and acute lung conditions immediately, and not spend enough time considering a broader differential. So when you can't figure out with a patient, think broader! Widen the diagnosis! Don't narrow it down too fast (this is something I have a problem with, so I really thought this experience taught me a good lesson)

And just so you know, they did an IV antibiotic drip (I was lucky to get the word "lingula" from my brother, definitely did not get the names of the medication), then sent her home with 5 days worth of Moxifloxacin, an inhaler, and pain medication (because the chest pain is still there). And she's doing a bit better now. Thank goodness for smart ER providers!

Ah, Pediatrics

What can I say? It's a complete review of pretty much everything we've learned so far this busy, busy year. So my day is study, study, study. How boring. The business of running errands is complicated by the fact that once you're outside in the sun/rain/hail/snow you most definitely do not want to go home after you've finished, sit down at your desk in your dark room, head bent over papers and laptop frantically trying to stuff etiologies, manifestations, and treatment plans into your already over-packed cranium. The light at the end of the tunnel is that spring break officially starts with the completion of the pediatrics test, only 5 days away now. The frightening part is that after spring break, we only have the Emergency/Surgery module, and Whole Patient module before we have our first PPS to prepare us for the coming year of rotations, and then it's out to our clinicals! Clinical rotations start May 17, which at the moment is just about exactly 9 weeks away. So studying our pediatric-review-of-everything-we're-supposed-to-already-know is slightly intimidating because it means finding that there are BIG gaps in memory of what we've already covered...oh well! Power on to get through Pediatrics to our wonderful, blissful, carefree week off!

The Beginning of the long Road

The Road goes ever on and on
Out from the door where it began.
Now far ahead the Road has gone,
Let others follow it who can!
Let them a journey new begin,
But I at last with weary feet
Will turn towards the lighted inn,
My evening-rest and sleep to meet.
-JRR Tolkein, LOTR

Man, I wish I could sleep right now.... Oh well, more stuff to prepare for clinicals (background check, drug test, packing, car checkup, etc), not to mention studying for the last few modules...