Chest Pain – Induction

You are assessing a 60 year old man who reports he had an episode of indigestion like epigastric pain that radiated into both shoulders and was associated with sweating and an episode of vomiting.  This lasted around 20 minutes.  You note a background history of GORD, diabetes and hypertension.  You have requested an ECG and vitals signs are recorded with a NEWS2 score of 0.

Examination reveals a soft systolic murmur and epigastric tenderness without guarding.

Which features exclude Acute Coronary Syndrome (ACS) as the cause of his pain?

Your next patient is a 54 year old lady who presented with a couple of days history of chest pain, its sharp in nature and catches when she takes a deep breath.  She has no significant past medical history, takes no regular medications.  Examination is unremarkable with no signs on chest exam and her calves appear normal size and symmetrical.  Her heart rate is 90 Blood pressure 132/76 RR of 18 and oxygen saturation is 95% in room air.

What is her PERC score?

What history features should concern you that a diagnosis of aortic dissection should be considered?

What features are likely to be present in tension pneumothorax.