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Question: Chest Pain

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You are seeing a 10 year old recently moved to the U.S. from Mexico with left sided chest pain for one day, and a fever to 38.2. Lung sounds are clear, the O2 sat is 100% on room air, and the CXR is negative. The ECG shows diffuse 1mm ST elevations and PR depression. The patient is well appearing with normal vital signs and hemodynamics.

What is the best management plan?

pemsou5_wp • June 19, 2018

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  1. Kelly June 19, 2018 - 4:19 pm Reply

    A. PPD and NSAIDS. The patient presents with signs of pericarditis, including chest pain, low-grade fever, and ECG with diffuse ST elevation, and PR depression. A pericardial friction rub would be pathognomonic for pericarditis. The most common cause is viral (so would not start antituberculosis medications empirically), although TB is a potential cause. A pericardial effusion requiring pericardiocentesis would presumably result in hemodynamic instability or at least tachycardia.

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