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Chest Pain Following Blunt Trauma In A High School Football Athlete - Page #1
 

Author: Skyler Gick, DO
Co Author #1: Anthony Ceraulo, DO
Senior Editor: Siobhan Statuta, MD, FAMSSM
Editor: Brian Cervoni-Rosario, MD

Patient Presentation:
A 15 year old male high school football athlete sustained a direct hit to his chest over the xiphoid process by an opponent's helmet.

History:
Following the hit, the patient immediately had chest pain and shortness of breath with associated mild epigastric abdominal pain. He did not lose consciousness but had persistent vomiting once on the sidelines. He was eventually sent to a local hospital by ambulance.
By the time they arrived to the emergency department, his dyspnea and vomiting had resolved. The patient was given intravenous fluids, was placed on a "nothing by mouth" status, and transferred to a pediatric hospital to be admitted for observation.
Patient had a past medical history notable for eczema.
Patient did not have history of prior surgeries.
Social and family history were unremarkable.

Physical Exam:
Vitals:
BP: 136/70, HR: 94, RR: 18, Temperature: 98.2F. Glasgow Coma Scale: 15.
Musculoskeletal: Chest wall symmetric, without deformity, and atraumatic in appearance. Tenderness to palpation over the sternum, xiphoid process, and ribs 6-10 bilaterally. No swelling or ecchymosis noted. No crepitus. No cervical spine, thoracic spine, or lumbar spine tenderness to palpation.
Heart: Regular rate and rhythm. No murmurs, gallops, or rubs.
Lungs: Lung fields were clear to auscultation bilaterally with normal lung sounds. No respiratory distress.
Abdomen: Bowel sounds present. Soft. No distention or guarding. Epigastric tenderness present.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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