Concerned about daughter *in A&E*

[Unsure1899]

Really worried about daughter.

She’s 15 for context. Woke me up about 2am- excruciating pain in middle of chest- really tearful saying her chest hurts more when she lays down or tries to take a deep breath. Gave OTC painkillers- tried distraction etc. Sat downstairs to see if painkillers helped. They didn’t. At 4am I brought her to A&E as she was beside herself in pain.
Triaged in Peads V quickly, ECG fine. Obs normal. Awaiting X-ray but I’ve asked if this could be linked to starting contraceptive pill a month ago (progesterone only). Doctor has pulled a face and he’s said it’s unlikely. No blood tests at this point, I’m worried that she potentially has a blood clot due to pain and where it is. I’m not great at being strong and firm but feel like this X-ray will come back clear and we will be sent home with muscular pain!l

Should I push further?

Glad they're doing blood test now.
My Ds had vomiting & chest pain last July. A&E were quite dismissive until they checked his bloods. His Tryponin (should he around 5, was 2.5k - he was in heart failure). Don't leave until they check bloods. Ds also Autistic (not easy in A&E). Thinking of you x

This is spot on. I work in CAMHS and we see this very often with our eating disorder and ARFID patients.

I hope she feels better soon

Great that they’re doing the blood test. Better to be sure. At least then if they say it’s something else you can be confident they’ve ruled a clot out.

@Poppetypop. It may be "spot on" as a possibility. It is not spot on as a diagnosis. You are not assessing the op's daughter clinically and "working fir CAMHS" does not equip you to make a clinical diagnosis.

@Unsure1899 it may be linked to ARFID. That is, as yet unconfirmed and cannot be without a test. It may be the cause or it may be ruled out.

Please stand firm. I find the words "I have raised concerns and you have disagreed. Please could you note in the records that the patient/carer requested further follow-up and it was refused".

I hope A&E fully investigate the chest pain.
Regarding the ARFID the NHS and CAMHS are generally not aware that it can be infection triggered at the root cause. Please do research PANS PANDAS and join the Facebook support group to look into this privately.

Costochondritis is REALLY painful, so yes, that is still a possibility.

I am just bewildered by posters asking if the doctors have listened to her chest, checked her oxygen levels, etc. I mean - really??!! Do you seriously think if you go into A&E complaining of chest pain, the doctors might not consider that would be a good starting point?

Nobody ever listened to DD’s chest on either of her a&e visits with chest pain. 🤷‍♀️

When I had this pain it was my oesophagus.
If she’s not eating a lot and takes tablets it can cause this pain.

I think you're right and see OP has goggles and got same answer.

And the reason is I know over 40's, smokers and those at higher risk of clots are given mini pill instead of combined pill.

Although I think it's because the risk is MUCH lower rather than non existent?

(I have no medical training whatsoever and am basing this on when I had adenomyosis and before diagnosis when periods were heavy was prescribed mini pill due to risk factors)

I hope you get answers quickly.
It’s no joke being in A&E with a neurodivergent kid is it?
I had 12 hours of hell with an ADHD'er with concussion.
He took a lot of persuading to stay and kept threatening to walk out and walk home 8 miles.
He too just wanted to go home to sleep but we had to wait for a scan of his head.
x

They would pick up on pneumothorax pretty quickly thankfully.

@Wilfrida1 unfortunately yes some of us have direct experience of an A&E missing basics (eg my exH was sent home without even a blood test after paramedics took him in with a positive result on his scan). With my Ds we were in a corridor for hours and I was initially told I was overanxious about his 'D&V' (it was heart failure from Peri and Myocarditis - we only just discovered from notes he was also treated for MI) OP is doing the right thing to ask questions.

I have suffered from this pain periodically since a teenager and in my case it's costochondritis

www.nhs.uk/conditions/costochondritis/

I would ask them to also check for gallstones, the pain is similar and does wear off after time. Just a suggestion

Don't want to be dismissive, but could it possibly be heartburn?

I've had such severe heartburn in the past that yes, it feels like a heart attack, can't get in any comfortable position and laying down does make it worse.

Particularly as she's not eating properly at the moment...

Gets worse when lying down? Could be pericarditis - was with my ds

Though they would know from ECG if it is.

Surely blood tests should have been a standard procedure. I have had a PE, make sure this is definitely ruled out .

I was thinking that, I get that sometimes and all I can do is just take an extra naproxen and it subsides. But it acts just like a heart attack type pain because it goes up to my jaw as well. Sometimes it does wake me in the night.

I hope she’s ok, and hope you get to the bottom of it!

I bet they love you in A+E!

With a history of an eating disorder ARFID, I would request bloods also to check potassium and calcium ok.

Yes I agree.

I was in urgent care last week with suspected DVT, and the first thing they did was the blood test. As I understand the D Dimer blood test can rule it out completely if it comes back at a normal level but if the results are high (like mine were) then they investigate further.

Not sure if it's the same for suspected PE? But bloods are (generally) easy to collect and results are within the hour so it's a good starting point?

Hoping your DD feels better soon and they rule out anything serious.

I get costochondritis as I have fibromyalgia. The pain can be truly horrific, spreads into my neck and jaw sometime so can mimic heart attack symptoms. But I know what it is, know what works to relieve it.
@CerealPosterHere advice on the blood test earlier is spot on as this is new for your daughter OP and needs to be thoroughly investigated, not fobbed off with “ it’s probably only”

Im not being funny but who cares as long as you’re polite. I’m amazed dd is still alive after being sent away from a&e with no blood test and textbook PE symptoms. And I’ve read about so many similar cases since. I’d never have forgiven myself for not being more of an advocate for her if she had died.

Has anyone given her some gaviscon?