LUNGS: Clear to auscultation bilaterally.
ABDOMEN: Soft, nontender, nondistended.
EXTREMITIES: No clubbing, cyanosis or edema.
NEUROLOGIC: Nonfocal.
A 12-lead ECG was obtained (Figure 11.1), and the patient
was placed on the cardiac monitor. A peripheral intravenous
line was placed, and blood was drawn and sent for laboratory
testing. The patient received aspirin 162 mg orally and
morphine sulfate IV for his pain. A portable chest radiograph
was obtained (Figure 11.2). Laboratory results were significant
for a positive D-dimer; the remainder of the laboratory
tests (complete blood count, electrolytes, creatinine, glucose
and troponin I) were normal.ACT angiogram of the chest did
not demonstrate evidence of pulmonary embolism. A second
troponin I obtained eight hours after the onset of symptoms
was normal (