A recent case highlights a common conundrum that happens to the best of us. You are presented with a situation where you simply do not know what to do.
A 23 yr old patient presented with tachyarrythmias following a night of heavy drug and alcohol use. Her presenting vitals are normal. Her toxidrome is clearing and her level of consciousness has improved. She however has chest pain and her heart rate remains 140 despite fluids, ativan and cooling. She had used some ecstasy and marijuana and a lot of alcohol. At one point she had an ECG that seemed to look like Atrial Fibrillation but the subsequent ones show a sinus tachy. You get a D-Dimer and a set of enzymes that are negative. Your chest X-ray is negative. You do a POCUS which is negative. Her parents then come to the department. You learn that her father is a family doctor in town and her mother is a radiologist in a rural hospital you have worked at. They have numerous questions about the chest pain that the young lady is experiencing and make some phone calls to their friends who include some cardiologists and internists that you know of. They all throw around some diagnoses that include PE, myocarditis and boor haves, none of which look like her current problem. She is rather chatty with her parents but very withdrawn with you and almost seems to dislike you. Her parents are equally frustrated with your lack of answers. They do not feel like they can take her home. You are past your shift being over and your very nice colleague hears your long winded talk with the parents and says “don’t handover me that”. You give cardiology a quick call and they say “please do not refer us these types of cases. She has a sinus tachy with a chest pain NYD”. You are now exasperated. What do you do?