In the ED, their vitals/exam are as above. Patient’s symptoms are likely MSK in origin. However, given patient’s age/history/persistent arm symptoms, unstable aortic aneurysm/dissection is on differential, as is ACS with this left symptoms being the patient’s anginal equivalent. Upper extremity is warm and well-perfused with 2+ radial pulse making acute limb ischemia less likely. No neck tenderness to palpation/reproduction of symptoms with neck range of motion making cervical radiculopathy less likely, albeit it is still in the differential. Low suspicion for DVT given arm is not vascularly congested and without color change. No signs or symptoms to suggest cellulitis. No focal tenderness to palpation to suggest bruise/fracture/dislocation. Myositis is always on differential and hence will obtain CK.
– Labs/Tests: CBC, CMP, Trops x2, BNP, CK to rule out myositis, PT-INR, T&S, COVID-19 RT-PCR
– Imaging: BSUS, CXR, CTA chest
– Treatments: None at this time. Will defer full ASA 325mg (dissection on differential)
– Consults: None at this time. Cardiology if rising trops, Cardiac/Vascular surgery if found to have evidence of dissection
– Dispo: Pending further testing. If work-up negative, anticipate admission to obs vs. medicine for stress test