Age: 30-year-old Height/Weight: 6’0’/ 190lbs Gender: Male Race: White Chief

Age: 30-year-old Height/Weight: 6’0’/ 190lbs Gender: Male Race: White Chief Complaint (CC): “I have chest pain, I thought I was dying. It’s gone now but it hurt so bad” HPI: This is a 30-year-old White male, with no PMH, who presents to the ED with a chief complaint of chest pain. He reports the pain started while he was hanging out with his friends and barbecuing outside his porch (none of whom report any illness). Patient described his pain as a sudden onset, non-radiating, pointing to the left side of his chest, that felt like “an elephant was sitting on my chest”. Mr. A stated the pain lasted for a period that lasted 30 minutes, but it went away 20 minutes ago when his friend blasted the AC in the car on their way to the ED. He reports his pain is currently 0/10, but it was 10/10 when he had the chest pain, and couldn’t catch his breath. He stated he never experienced this pain before, and did not take any medications for it. The chest pain was accompanied with dizziness, and headache. However, the headache has now gone away, but he is still feeling a “little lightheaded”. He reported nothing made the pain worse. Mr. A stated he was eating hot dogs and hamburgers, and had “a couple of beers”. Patient denies heartburn, palpitations, and weakness. Home Medications: – No prescribed or OTC medications – No herbal supplements, or vitamins Past Medical History: – No past medical history Surgeries: – No surgeries – No recent procedures Past / Recent Hospitalizations: – Never been hospitalized Family History: – Dad: died from a heart attack at age 59 – Mom: had died DM; died at 67 from DM complications Social History: Single /Married/Separated/Divorced: Single, lives with his girlfriend Occupation: Construction worker Smoke: – Smokes 1 ½ packs per day for 12 years) – Smokes marijuana every weekend Alcohol: – Drinks approximately 7 bears every weekend Recreational Drugs: – Denies cocaine use – Denies the use of other illicit drugs Nutrition: – “Pretty healthy diet” – Drinks energy drinks 1-2 times a week – 1 cup of coffee every day Allergies: No known allergies No recent travel REVIEW OF SYSTEMS GENERAL HEALTH: Denies diaphoresis, weakness, and fatigue. NEURO: + Dizziness and lightheadedness; + Headache (when he had the chest pain, it’s gone now). Denies numbness, tremors, shaking, and seizures. HEENT: Denies vision changes, sore throat SKIN: RESPIRATORY: + SOB (when he had chest pain, it’s gone now). Currently denies SOB. Denies cough CARDIOVASCULAR: + Chest pain (20minutes ago, currently denies chest pain). He stated it hurts when pressure is applied on his chest. Denies palpitation GASTROINTESTINAL: Denies abdominal pain, constipation, vomiting, heartburn. GENITOURINARY: Denies hematuria, and dysuria. HEME: PERIPHERAL VASCULAR: Denies hx of blood clots, and claudication. MUSCULOSKELETAL: Patient feels like he strained a muscle while pulling the grill inside from the rain ENDOCRINE: Denies heat and cold indolence, and excess sweating. PSYCH: Occasionally anxious due to stress from work, but not today. Denies depression. No thoughts of hurting self PHYSICAL EXAMINATION Vitals: BP: 154/98, HR 104pbm, RR 26bpm, T 99.9F, O2 99% on RA General: Appropriate mood and affect, appears stated age, ETOH and smoke odor to breath Eyes: PERRLA, sclera white, conjunctiva pink, cornea clear, no foreign body, edema, lacerations, anterior chamber clear, lacrimal ducts normal, fundi clear. Ear: No external ear erythema, edema, lesions. Unobstructed ear canal with no edema, discharge, lesions. Tympanic membrane clear with normal light reflex. Nose: External nose symmetrical, nares open, no lesions. Turbinates normal color, size, and shape. Mucus clear. Throat: Lips normal color, tongue normal shape and color, hard and soft palates normal color, intact teeth with no remarkable features, tonsils normal shape and size, uvula normal shape and color. No erythema, exudates, adenopathy. Neck: Symmetrical, trachea midline, normal ROM, nontender. No adenopathy, thyromegaly, masses, or skin lesions. Chest: Symmetrical, CTA+P bilaterally, non-tender, normal lung excursion. No wheezing, rales, rhonchi, no accessory muscle use. Cardiovascular: Normal S1 and S2, regular rate and rhythm. No S3 or S4. (+) Abdominal: soft, non-tender, non-distended, + BS all 4 quads. No hepatomegaly, splenomegaly, masses, or bruits. Labs: ABG: 7.35 / 45 / 40 / 22 Lactate: 1 Carbon monoxide: 120 Oxyhemoglobin: 79% Methemoglobin: Negative Carboxyhemoglobin: 21% Cyanide levels: Negative EtOH: 0.15 mg/dL Trop: Negative Urine Toxicity: + for THC, everything else negative CBC, CMP, LFTs, UA, Coags: WNL BUN: 36 Cr: 0.9 CK: 36 B12 levels: Normal Iron: Normal Imaging CT brain r/o stroke: Negative EKG: Sinus tachycardia, no ST changes CXR: WNL Assessment: Mr. A is a 30-year-old male, with no PMH, who presented to the ED with a chief complaint of chest pain for a period that lasted 30 minutes, which ended 20 minutes ago, found to have carbon monoxide poisoning. DIFFERENTIAL DIAGNOSES must list at least 8 differential dx, explain why you think Mr. A could have them with pertinent positives and pertinent negatives: Plan must be specific and based on the evidence

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