Case of the Week — March Case #1: Chest Pain

52 y/o AAM presents to the ED with 3 days of cough, pleuritic chest pain, SOB, and night sweats. Pain is substernal, sharp, worse with deep inspiration/coughing and non radiating. Pain is 10/10. Upon further questioning, the patient admits to streptococcal pneumonia and bacteremia 10 days prior, only partially treated with rocephin. PMHx: latent tuberculosis PSHx: none Meds: Ibruprofen, theraflu Allergies: NKDA FamHx: diabetes SocHx: lives alone, denies tobacco and ETOH, admits to cocaine PE: BP 134/80, P 116, R 22, T 98.1, Pox 100% on 2L NC GEN: thin AAM HEENT: dry mucous membranes, no JVD CV: tachycardic, regular, + friction rub, no peripheral edema CHEST: shallow and rapid, diffuse rhonchi ABD: soft, NTND, +BS NEURO: no deficits EKG illustrates the following: Bedside Ultrasound is performed: What is the diagnosis? How would you treat this in the ED? Thanks to Dr. Dileep Ravi for submitting this case!