You begin your morning ED shift with a brief sign out (two sleeping midnight brawlers waiting to “metabolize to freedom”, and one pregnant patient with vaginal bleeding waiting on an OB consult), ahhh a nice, slow morning at the Copa. Thinking you should probably get some breakfast before everyone wakes up and realizes they need to come to the ED, you pick up your first chart of the day; a 19 year old female with palpitations. “Probably another ASU coed with a red bull overdose” you joke to yourself as you walk back to her room. You find a young Hispanic female who is slightly tachypneic and anxious, pacing in her room while clutching her chest. She explains in a single 2 minute run on sentence that she has been feeling her heart racing for about an hour, she has had this happen several times before in the past and it always goes away when she relaxes, but today is just wont go away, she just keeps worrying about her heart and it keeps beating faster and faster, she keeps worrying about having a heart attack or dying or something really, really bad and it just keeps beating faster and faster and faster and faster….With you impressively calm bedside manner, get her to relax enough to sit on the side of the bed. You check her pulse and it’s way too fast to count, but strong. She says that she is feeling light headed, so you have her lie down on the bed. Just then the ED tech walks in and says “Hey doc, mind if I do a quick ECG on her? We’ve got a trauma coming in 10 minutes and I want to get it done before I’m stuck up in the front room”. After a quick listen to lung sounds, which are clear as a Phoenix sky, you say, “Sure, I’ll be back in a couple of minutes”. You have just long enough to pound a quick coffee from the ED lounge and the tech hands you her ECG.

Anything you want to ask your patient about?