This case involved a 43-year-old female patient who presented to the emergency room following a motor vehicle accident. The patient complained of neck, shoulder, and hip pain. Upon exam, she was noted to have extremely high blood pressure. It was later discovered that the patient had not taken her antihypertensive medications. The patient was diagnosed with a muscle strain of the upper back and discharged home. One month later, the patient returned to the emergency room complaining of worsening back pain and spasms. Upon exam, she was noted to have paraspinal tenderness and spasms of the lumbar spine. Her blood pressure was also noted to be elevated. HEART scoring noted an elevated risk of adverse cardiac events. However, the patient was diagnosed with a muscle spasm of the back and discharged home. Several hours later, the patient was found in the emergency room parking lot unresponsive, apneic, and pulseless. The autopsy report noted the cause of death as cardiac tamponade due to a ruptured aortic aneurysm. An expert in emergency medicine was sough to review the patient’s medical record and opine on the care she received during the two emergency room visits prior to her death.