Robbie

Yeah.

But see, it's about defining the problem and getting the label right of the problem.

This easily could have gone into like, he has a subdural because he fell off his bike, and he has more continuous sense of uneasiness.

Yeah, you know, Parfraz, I think that the fact that he syncopized, I think just as a marker of... You know, the truth is we don't know he syncopized, but I think the fact that he came right back to it in the context of exertional lightheadedness, how does that be the wisest problem representation?

Yeah.

The fact that he's vomiting after is just, I think, a marker.

I don't create any specificity to it, but I think whenever you're seriously sick, some people get very sympathetic and some people get very vagal.

And you said he was hypertensive afterwards, which I think is just probably more autonomic than anything else in his body trying to recover.

So if I, you know, going back to the original differential diagnosis, which of those two, ACS or PE, I'm also tracking the possibility he might have something in his brain, Prof. Rez, but if he has ACS or PE, which one is more likely to present with syncope?

It's definitely a pulmonary embolism, though there are instances where ACS can present with syncope, but it would require a second-order mechanism, like it would require ACS-induced VT or ACS-induced... ACS purely presents...

with a continuous syndrome that gets worse and worse and worse and worse rather than PE, which has some cool mechanisms that can present with a syncopal event.

Beautiful.

Curious what the x-ray will show.

Okay.

Wow, this is very, very different.

Crazy x-ray progress.

So, you know, the major abnormality in this x-ray that I see is that his mediastinum looks really, really odd and really enlarged.

So I'm trying to make sure I'm not missing a pneumothorax.

I don't see that.

I don't see any pleural disease.