A 35-year-old man presents to the emergency department following an unrestrained head-on collision where his chest struck the steering wheel. During the initial assessment, the patient abruptly begins complaining of incredibly severe chest pain that feels like ripping in the anterior chest. He states, “I’m going to die, I know it!” The nurse alerts the provider immediately due to suspicion for which condition?

Question

A 35-year-old man presents to the emergency department following an unrestrained head-on collision where his chest struck the steering wheel. During the initial assessment, the patient abruptly begins complaining of incredibly severe chest pain that feels like ripping in the anterior chest. He states, &ldquo;I&rsquo;m going to die, I know it!&rdquo; The nurse alerts the provider immediately due to suspicion for which condition?

Accepted Answer

Aortic dissection. The history of mechanical trauma to the chest, description of anterior chest pain that feels like ripping or tearing, and premonitions of death point to aortic dissection, which is fatal unless treated immediately. Aortic aneurysm is generally not painful and is usually diagnosed by screening or as a result of testing for another condition. Myocardial infarction is generally described as crushing chest pressure, not ripping, chest pain. Moreover, the patient is rather young for an MI. Pulmonary embolism is generally associated with sudden onset difficulty breathing and pleuritic chest pain.

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