MDM - Chest Wall Pain

[##]-year-old [male/female] with chest pain with history and exam consistent with likely chest wall pain.

Initial consideration in this patient included chest wall pain including costochondritis, Tietze’s synbdrome, and precordial catch syndrome, angina pectoris, acute coronary syndromes (ACS), pulmonary embolism (PE), aortic dissection, spontaneous pneumothorax, pneumonia, and esophageal pathology amongst others. 

Patient presented with chest pain described as [localized/reproducible/sharp] and associated with [movement/recent increase in activity/describe strain/etc.].  The patient was felt to be low risk for PE based on a low risk Wells score and being PERC negative.  A 12-lead EKG was obtained with no evidence of dysrhythmia, ischemia, infarction, or other significant acute abnormalities.  Doubt cardiac etiology at this time given unremarkable EKG in patient without significant risk factors for acute coronary episode.  Plain films of the chest [were obtained with no evidence suggestive of dissection, pneumonia, pneumothorax, or other significant pathology/were not felt to be indicated at this time given absence of abnormal lung sounds or other significant risk factors for acute intrathoracic processes].  Considered esophageal etiology unlikely based on absence of relation to eating or other suggestive features.  Patient reported significant improvement with [treatment] prior to discharge from ED.

We discussed return precautions, specifically for evidence of persistent or worsening chest pain, symptomatic treatment [with analgesics/NSAIDs], and follow up with primary care doctor within [2-3 days/1 week] for further evaluation, and the patient demonstrated understanding and agreement with this plan.