It's 3am, a 55 year old male come to the ED with chest pain | Figure 1

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It's 3am, a 55 year old male come to the ED with chest pain started the previous day at 7am (!!!). When the ecg is taken the pt is in pain. He took FANS for pain at 11am of the previous day. Dx and treatment?

Case Details

Case 1

48 years, woman, non smoker, arterial hypertension (good control with enalapril 20 mg/day, long term use). Dry cough since the previous day and slight to moderate dyspnea today. Normal vital signs. Deny fever, nasal or dyspeptic symptoms, previous history of bronchoespasm. When asked, refer an inespecif pain at right hemithorax on previous day with spontaneous remission after few minutes. Toughts about most likely diagnosis and x ray signals? ( Sorry about the bad quality, had just the window with light on the moment ).

Case 2

Patient is a 64 year old male with PMHx of HTN and DM presents for 3 day worsening right elbow pain. Patient denies previous history, fever/chills and trauma.

Case 3

The previous patient after 3 days of treatment by Dx of shingles.

Case 4

30 years old, female, without previous illnesses. Two days ago, continuous and intense abdominal pain started in the lower right quadrant of the abdomen. She was medicated with intravenous Tramadol, but the pain did not improve. She did an abdominal tomography with the images above. Any diagnostic hypothesis?

Case 5

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Case 6

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Case 7

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Case 8

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?