year old white male with a history of ethanol abuse, bronchial asthma
and hypertension presents to the ED with a six hour complaint of severe
chest pain. He became markedly dyspnic two hours prior to his presentation.
Physical exam reveals that the patient is in marked
respiratory distress and complains of lower anterior and posterior chest
pain. BP 110/70 mm Hg in the right arm. Pulse is 110/min and regular.
Respirations labored at 35/min. He is afebrile. Neck veins are flat at
30 degrees and there is no HJR.