33 y/o M w/ no significant PMH presents to the ED with c/o not feeling well x1 week. Pt has a history of Percocet use, 3-4 tablets of 10mg/325 daily for about one month which he decided to stop using abruptly on New Year’s Day. Denies cocaine/alcohol use. Symptoms include chills, sweats, malaise, nausea. Patient thought he was withdrawing and went to PMD gave clonidine. He has been taking it twice a day w/o improvement. He is having trouble sleeping because of feeling restless and anxious, and SOB. Pt thought he was anxious and again attributed his sx to withdrawal; took one dose of Xanax and was able to sleep, but it didn't help with the restlessness.
VS: T 96.5F P 107 RR 20 BP 119 /75 SPO2 96 RA
REVIEW OF SYSTEMS:
CONSTITUTIONAL: (-) fever, (+) general weakness,
CARDIOVASCULAR: All Negative.
RESPIRATORY: (+) SOB exertion,
GASTROINTESTINAL: All Negative
MUSCULOSKELETAL: All Negative
INTEGUMENTARY: All Negative
NEURO: All Negative
CONSTITUTIONAL: The patient is alert and anxious, NAD.
CARDIOVASCULAR: Rate: Tachycardia. Rhythm: Regular.
RESPIRATORY: Breath sounds clear, no distress present, no wheezing rales, rhonchi or tachypnea. Normal rate and effort.
GI/ABDOMEN: Soft, non-tender, no organomegly, no pulsatile mass. Normal bowel sounds.
MUSCULOSKELETAL/EXTREMITES: Non-tender, normal ROM, no pedal edema or calf tenderness. NVT intact.
NECK: The neck is supple, no JVD, thyromegaly, or lymphadenopathy.
INTEGUMENTARY: Color normal for race, warm and dry, no rash.
NEURO: Oriented x3. Cranial nerves II-XII within normal limits. No motor or sensory deficits.
PSYCH: Oriented x3, mood and affect is normal.
CK = 299
Troponin = 0.15; CKMB = 5.6
CBC, CMP and coag - WNL
- What findings can you see in the EKG below?
- What is the differential diagnosis?
- What findings are seen on the ultrasound video below?
- What minimal quantity of fluid do you need to be able to see these findings?
- Sinus tachycardia, LBBB
- viral myocarditis, drug-induced myocarditis, cardiac ischemia
- mild pericardial effusion, moderate pleural effusion, dilated LV
- pericardial effusion - 50 mL and pleural effusion - 150 mL