Carolinas Case Conference

1. ACS in the elderly can be tricky. Presentations can be subtle with the most common symptoms being chest pain, shortness of breath, diaphoresis and nausea. Patients > 65 who present without chest pain who have ACS have significantly higher mortality.

2. When making a diagnosis of DVT/PE consider why this patient is hyper-coagulable. Seek common etiologies and refer or admit for further workup if necessary.
 
3. Consider vascular surgery consult for large DVTs in proximal vessels in patient's with low risk for bleeding complications, as these patients may benefit from catheter directed thrombolysis or thrombectomy.
 
4. Signs of traumatic aortic injury include: widened mediastinum, abnormal contour of aorta, depressed left mainstem bronchus, deviation of NGT to right, loss of aortopulmonary window.

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