The EM Educator Series: Not Your Typical Chest Pain Case

Author: Alex Koyfman, MD (@EMHighAK) // Reviewed by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 22-year-old male presents with diffuse nausea, vomiting, and chest pain, followed by back pain and chills. Vital signs reveal tachycardia and fever, but normal blood pressure and oxygen saturation.

Case 2:

A 45-year-old female presents with shortness of breath, with a recent upper endoscopy performed 2 days ago for esophageal dilation.

Considerations:

• What are the etiologies and pathophysiology of esophageal perforation?
• How can patients present with esophageal perforation?
• What is the differential diagnosis for pneumomediastinum?
• What is the ED evaluation?
• What is the ED management?
• When should you consider an antifungal in the ED setting?

Suggested Resources:

• Articles
  • emDocs Case
  • Esophageal Perforation Pearls
  • LITFL
  • Core EM
  • IBCC Antifungal therapy
• Journal Articles
  • EM Clinics of NA – Elderly Chest Pain

JEM Case – Rare but Lethal Cause of Chest Pain