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An 81-year-old man was admitted to the hospital because of pain and subcutaneous emphysema in the right upper extremity.
The patient was in a stable state of health until one day earlier, when he was admitted to another hospital because of the onset of increasingly severe pain in the right shoulder. An electrocardiogram showed sinus tachycardia at a rate of 100, with evidence of anterior subendocardial ischemia and occasional premature ventricular contractions with a single morphologic pattern. A nitroglycerin infusion was begun by vein. Early on the next morning subcutaneous emphysema was observed about the right shoulder and right chest
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