I would have asked whether he felt something stuck as his chest pain may
have been related to oesphageal food impaction. If you have done the ECG
though he would need cardiac enzymes and probably cardiology consult and
admit for observation overnight.
>Approved-By: [log in to unmask]
>X-Mailer: Excite Inbox
>Date: Sun, 3 Sep 2000 08:59:18 -0700
>Reply-To: Hugo Dowd <[log in to unmask]>
>Sender: Pediatric Emergency Medicine Discussion List
> <[log in to unmask]>
>From: Hugo Dowd <[log in to unmask]>
>Subject: 12 yo boy with chest pain
>To: [log in to unmask]
>12 year old Duchennes MD ( spontaneous mutation) who is chairbound for 3
>years attends Ped ER with chest pain 4 hours after eating a doughnut on his
>birthday. A stir fry was eaten by the whole family the night before and
>everyone else in the house is well.
>His mum is concerned he has dyspepsia but it has not settled on over the
>He is not on regular medication and has no known allergies.
>No family history of sudden death, IHD, hyperlipidaemia etc.
>In the dept while having an EKG his condition worsens. He becomes
>increasingly anxious. He denies palpitations.
>Immediately after being given gaviscon he vomits partially digested food and
>feels immediately better.
>His ECG has an infero anterior ishcaemic pattern.4 mm depression V1, 3mm
>V2,St elevation of 5 mm on 1,2, 3mm on 3 and avF and 2 mm dep on avR
>His first BP is low ( sys 70) but with an appropriate sized cuff it is in
>within normal limits ( sys 110) for his age and weight. There is no
>dysparity in the arm BP and there is no radio-femoral delay
>What next folks?
>Paediatric Emergency Department
>Bristol Children's Hospital
>St. Micheal's Hill
>University Hospital of Wales
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>For more information, send mail to [log in to unmask] with the
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>The URL for the PED-EM-L Web Page is:
Dr. Peter Barnett MBBS FRACP MSc(epid) FACEM
Department of Emergency Medicine
Royal Children's Hospital
Telephone + 61 3 9345.6592
Facsimile + 61 3 9345-5938
E-mail [log in to unmask]
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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