Instructions

In each issue of The Internet Journal of Emergency and Intensive Care Medicine we present a new case that has controversial diagnostic and management issues. Please read the following case and provide us with your expert opinion. In a few weeks we will include the final diagnosis

Case description

A 30-year-old woman presented to emergency department approximately fourteen hours following a motor vehicle accident. The patient was driving approximately 25 – 35 mph when she front ended another car. Airbags had deployed. On arrival the patient complained of left-sided anterior chest pain that was worse with deep breathing. She also reported some lightheadedness and shortness of breath upon arising from a sitting and lying position.

Examination revealed a very thin female with bony tenderness over the left anterior ribs. One examiner reported a bony step off. Cardiac exam was normal and breath sounds were clear bilaterally. Radiographs of the ribs and chest revealed no abnormalities.

Electrocardiograph on admission is shown in the figure:

Questions

• How would you describe the electrocardiogram?

• Would you admit this patient? If so, why?

• Please e-mail your answers to jvaron@ispub.com