© 2002 Evidence-Based Medicine
EBM notebook
Textbook descriptions of disease — where’s the beef?
1 Wright State University
Dayton, Ohio, USA
2 Wake Forest University
Winston-Salem, North Carolina, USA
| The first 150 words of the full text of this article appear below. |
A resident asks you, the attending physician in an emergency department, to see a 68 year old woman with severe pain in her chest. The pain’s location (retrosternal, radiating through to her back), quality ("tearing"), and onset (sudden, not crescendo) prompted the resident to think of acute aortic dissection along with other causes of chest pain; however, because the examination shows symmetric pulses in her arms, the resident dismisses dissection and plans no test to exclude it. You recall that pulse asymmetry may not occur in some patients with dissection, but you cannot recall the proportion. Nevertheless, you suggest that the absence of this finding should not be used to exclude dissection, and you decide with the resident to order further testing for this condition. To refresh your memory and teach the resident when to pursue this diagnosis, you seek information on how frequently patients with dissection have asymmetric pulses.
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This article has been cited by other articles:
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KING, D. B, DICKINSON, J. A, BOULTON, M.-R., TOUMPAS, C.
(2005). Clinical skills textbooks fail evidence-based examination. Evid. Based Med.
10: 131-132
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