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| ==Overview==
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| ==FIRE: Focused Initial Rapid Evaluation==
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| A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
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| <span style="font-size:85%">Boxes in the red signify that an urgent management is needed.</span>
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| <span style="font-size:85%">'''Abbreviations:''' </span>
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| {{Family tree/start}}
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| {{familytree | | | | | | | | | | D01 | | | | | | | | | D01=<div style="text-align: center; width: 15em"> '''Identify cardinal findings that increase the pretest probability of life-threatening chest pain'''</div> <br> <div style="text-align: left; width: 15em"> ❑ Sudden onset <br> ❑ <br> ❑ <br> ❑ Related physical exertion <br> </div>}}
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| {{familytree | | | | | | | | | | |!| | | | | | | | | | }}
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| {{familytree | | | | | | | | | | A01 | | | | | | | | | | A01= <div style="float: left; text-align: left; width: 15em; padding:1em;">'''Does the patient have any of the findings that require urgent management?'''<br>
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| ❑ [[Tachycardia]] <br> ❑ [[Hypotension]]<br>❑ [[Altered mental status]]<br>❑ Severe [[dyspnea]] <br> ❑ [[Oliguria]] <br> ❑ [[Cold extremities]]</div>}}
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| {{familytree | | | | | | | | |,|-|^|-|-|-|. | | | }}
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| {{familytree | | | | | | | | B01 | | | | B02 | | | | B01=<div style=" background: #FA8072; text-align: center; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF|'''Yes'''}} </div>| B02= '''No''' }}
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| {{familytree | | | | | | | | | |!| | | | | |!| | | | }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | | | | C01 | | | | | |!| | | | C01=<div style="float: left; text-align: left; width: 12em">'''Initiate resuscitation measures:''' <br> ❑ Secure airway <br> ❑ Administer oxygen if SatO2 ≤95% <br> ❑ Secure wide bore IV access <br> ❑ Monitor vitals continuously <br> ❑ Immediately order a 12-lead [[ECG|<span style="color:white;">ECG</span>]]</div>}}
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| {{familytree | | | | | | | | | |!| | | | | C02 | | | | | C02=<div style="float: left; text-align: left; width: 20em; padding:1em;"> '''[[Continue with the complete diagnostic approach below]]''' </div>}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | | | | | | A01 | | | | | | A01= <div style="float: left; text-align: left; width: 14em; padding:1em;">'''Does the [[ECG|<span style="color:white;">ECG</span>]] has [[ST elevation|<span style="color:white;">ST elevation</span>]]?''' </div>}}
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| {{familytree | | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | B01 | | | | | | | | B02 | | | | B01= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''YES''' </div> | B02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''NO''' </div>}}
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| {{familytree | | | | |!| | | | | | | | | |!| | | | | |}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | | C01 | | | | | | | | C02 | | | | |C01=<div style="float: left; text-align: center; width: 14em; padding:1em;">'''Is the ST elevation specific to an anatomic area?'''</div><div style="text-align: left"> ❑ V1-V2 (Septal) <br> ❑ V3-V4 (Anterior) <br> ❑ V5-V6 (Apical) <br> ❑ I, aVL (Lateral) <br> ❑ II, III, aVF (Inferior) </div> | C02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''Consider additional tests to rule out life-threatening conditions'''<br> ❑ ABG <br> ❑ Chest X-ray <br> ❑ D-dimer</div> }}
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| {{familytree | | |,|-|^|-|.| | |,|-|-|-|+|-|-|-|.| | |}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| D01 | | D02 | | |!| | | |!| | | |!| |D01=<div style="float: left; text-align: center; width: 14em; padding:1em;">'''YES''' </div> | D02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''NO''' </div>}}
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| {{familytree | | |!| | | |!| | |!| | | |!|| |}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| E01 | | E02 | | E03 | | E04 | | E05 | |E01=<div style="float: left; text-align: left; width: 14em; padding:1em;">
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| '''[[STEMI]]''' <br> ❑ Pain described as a heaviness or crushing sensation <br> ❑ Radiates to the left arm, neck and/or jaw <br> ❑ Not alleviated by rest or medications <br> ❑ PR depression is absent <br>
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| ----
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| '''[[LBBB]]''' <br> ❑ EKG evidence of LBBB
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| : ❑ QRS ≥ 120 ms
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| : ❑ QS or rS in V1
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| : ❑ Monophasic R in I, aVL and V6
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| ❑ Chest pain with same characteristic as STEMI </div> | E02= <div style="float: left; text-align: left; width: 14em; padding:1em;"> '''[[Pericarditis]]''' <br> ❑ Sharp and pleuritic pain that is improved by sitting up and leaning forward <br> ❑ Diffuse, non-specific ST elevation <br> ❑ PR depression <br> ❑ PR elevation in lead aVR </div>| E03=<div style="float: left; text-align: left; width: 14em; padding:1em;">'''[[Pulmonary embolism]]''' <br> ❑ Sudden[[chest pain]] <br> ❑ Severe [[dyspnea]] <br> ❑ History of [[DVT]], [[surgery]], [[malignancy]], immobility <br> ❑ Elevated [[D-dimer]]</div>| E04=<div style="float: left; text-align: left; width: 14em; padding:1em;">'''[[Pneumothorax]]''' <br> ❑ [[Dyspnea]]<br> ❑ [[Hypoxia]] <br> ❑ [[Tracheal deviation]] towards the unaffected side<br> ❑ [[percussion|Hyperresonance]] on the affected side </div> |E05=<div style="float: left; text-align: left; width: 14em; padding:1em;">'''[[Aortic dissection]]''' <br> ❑ Acute onset of [[heart failure]] <br> ❑ Low pitched early diastolic murmur best heard at the 2nd right [[ICS]] <br> ❑ [[Widened mediastinum]] on [[chest X-ray]] <br>❑ History of:
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| : ❑ [[Hypertension]]
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| : ❑ [[Marfan syndrome]]</div> | E06=<div style="float: left; text-align: left; width: 14em; padding:1em;">'''[[Unstable angina]]/[[NSTEMI]]'''<br> ❑ Pain described as a heaviness or crushing sensation <br> ❑ Radiates to the left arm, neck and/or jaw <br> ❑ Not alleviated by rest or medications <br> ❑ Pain last > 10 min <br>
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| '''[[Stable angina]]''' <br> ❑ Pain usually lasts < 10 min <br> ❑ Improved by rest or [[nitroglycerin]] </div>}}
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| {{familytree | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E01= <div style="float: left; text-align: left; width: 14em; padding:1em;"> '''Administer:'''<br> ❑ [[Aspirin|<span style="color:white;">Aspirin</span>]] 162-325 mg <br> ❑ [[Oxygen therapy|<span style="color:white;">Oxygen </span>]](2-4 L/min) if satO2 <90% <br> ❑ [[Beta blockers|<span style="color:white;">Beta blockers</span>]] (unless contraindicated) <br> ❑ Sublingual [[nitroglycerin|<span style="color:white;">nitroglycerin</span>]] 0.4 mg every 5 min for a total of 3 doses <br> '''Do not delay [[primary angioplasty|<span style="color:white;">primary angioplasty</span>]] or [[fibrinolysis|<span style="color:white;">fibrinolysis</span>]]''' <br>[[STEMI resident survival guide|Click here for the detailed management]]</div>| E02=[[Pericarditis resident survival guide|Click here for the detailed management]] |E03= [[Pulmonary embolism resident survival guide|Click here for the detailed management]]
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| | E04=[[Tension pneumothorax resident survival guide|Click here for the detailed management]]| E05= [[Aortic dissection resident survival guide|Click here for the detailed management]]| E06= [[Esophageal rupture resident survival guide|Click here for the detailed management]]}}
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| {{familytree/end}}
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| ==Complete Diagnostic Approach==
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| A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.
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| <span style="font-size:85%"> '''Abbreviations:''' </span>
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| {{familytree/start}}
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| {{familytree | | | | | | | A01 | | A01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Characterize the chest pain'''<br>
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| ❑ Onset (sudden or gradual)<br>
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| ❑ Location (retrosternal, epigastric, chest wall, diffuse)<br>
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| ❑ Type (sharp, pleuritic, heaviness, colicky)<br>
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| ❑ Radiation (shoulder, neck, back) <br>
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| ❑ Duration<br>
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| ❑ Worsen by (activities, position, drugs)<br>
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| ❑ Alleviated by (activities, position, drugs)</div>}}
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| {{familytree | | | | | | | |!| | | | | | | | | }}
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| {{familytree | | | | | | | Z01 | | Z01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Characterize the symptoms'''<br>
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| '''Non-specific symptoms'''<br>
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| ❑ [[Altered mental status]]<br>
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| ❑ [[Shortness of breath]] <br>
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| ❑ [[Nausea]] and [[vomiting]] <br>
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| ❑ [[Dizziness]] <br>
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| ❑ [[Syncope]]<br>
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| ❑ [[Fatigue]] <br>
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| ❑ [[Lethargy]]<br>
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| <br>
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| '''Symptoms suggestive of cardiac etiology'''<br>
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| ❑ Heaviness or crushing sensation (suggestive of [[myocardial ischemia]]) <br>
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| ❑ Radiating to left arm, neck and/or jaw (suggestive of [[myocardial ischemia]]) <br>
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| ❑ Interscapular pain (suggestive of [[aortic dissection]]) <br>
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| ❑ [[Epigastric pain]] (suggestive of [[inferior MI]])<br>
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| ❑ [[Sweating]] <br>
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| ❑ [[Palpitations]] <br>
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| ❑ Pain with exertion <br>
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| <br>
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| '''Symptoms suggestive of pulmonary etiology'''<br>
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| ❑ [[Pleuritic pain]]
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| : ❑ Sharp or knife-like
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| : ❑ Increases with [[respiratory movements]]
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| ❑ [[Dyspnea]] <br> ❑ [[Cough]] <br> ❑ [[Hemoptysis]] <br> ❑ Pain and [[swelling]] of lower extremities (suggestive of [[DVT]]) <br> ❑ Chills (suggestive of [[pneumonia]])
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| <br>
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| '''Symptoms suggestive of gastrointestinal etiology'''<br>
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| ❑ Burning sensation (suggestive of [[GERD]]) <br> ❑ Colic (suggestive of [[cholelithiasis]]) <br> ❑ [[Epigastric pain]] <br> ❑ Pain is associated with:
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| : ❑ Meals (suggestive of [[GERD]] or [[peptic ulcer]])
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| : ❑ Medication intake
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| : ❑ [[Swallowing]]
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| : ❑ Changes in position
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| : ❑ Wakening during night (suggestive of [[GERD]])
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| ❑ Relieved by antacids <br> ❑ Not related to exercise <br> </div>}}
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| {{familytree | | | | | | | |!| | | }}
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| {{familytree | | | | | | | L01 | | L01= <div style="float: left; text-align: left; width: 25em; padding:1em;"> '''Inquire about past medical history:'''<br>
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| ❑ Previous episodes of chest pain<br>
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| ❑ Cardiovascular disease
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| : ❑ Previous [[MI]] <br>
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| : ❑ [[DVT]] <br>
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| : ❑ [[Hypertension]] <br>
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| ❑ Recent medical procedures <br>
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| : ❑ CVC (suggestive of [[pneumothorax]])<br>
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| : ❑ <br>
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| ❑ Pulmonary disease<br>
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| : ❑ Previous [[PE]] <br>
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| : ❑ [[COPD]]
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| : ❑ [[Asthma]]
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| ❑ Neurological diseases<br>
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| ❑ Malignancy<br>
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| ❑ Recent [[trauma]]<br>
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| ❑ Alcohol intake <br>
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| ❑ Recent surgery (<3 months)<br>
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| ❑ Rheumatoic disorders
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| : ❑ SLE
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| : ❑ Rheumatoid arthritis
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| </div> }}
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| {{familytree | | | | | | | |!| | | }}
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| {{familytree | | | | | | | B01 | | B01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''Identify possible triggers or risk factors:''' <br>
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| ❑ <br> ❑ <br> </div>}}
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| {{familytree | | | | | | | |!| | | }}
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| {{familytree | | | | | | | Z01 | | Z01= <div style="float: left; text-align: left; width: 25em; padding:1em;"> '''Examine the patient:'''
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| '''Vitals'''<br>
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| ❑ Fever (suggestive of[[pericarditis]], [[pleuritis]] or infection)<br>
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| ❑ Heart rate
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| : ❑ [[Tachycardia]]
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| : ❑ [[Bradycardia]]
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| ❑ Blood pressure
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| : ❑
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| : ❑ Asymmetric blood pressure in extremities (suggestive of [[aortic dissection]])<br>
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| ❑ [[Tachypnea]] (non-specific)<br>
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| '''Neck'''<br>
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| ❑ Elevated [[jugular venous pulse]]<br>
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| '''Cardiovascular examination'''<br>
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| ❑ S3 <br>
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| ❑ S4 <br>
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| ❑ <br>
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| ❑ [[Pericardial rub]] (suggestive of [[pericarditis]])<br>
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| ❑ Murmur (systolic murmur in [[hypertrophic cardiomyopathy]], [[aortic stenosis]])
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| <br>
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| '''Respiratory examination'''<br>
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| ❑ [[Palpation]] - shift in trachea from midline ([[tension pneumothorax]])<br>
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| ❑ [[Auscultation]]
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| : ❑ Absent breath sounds <br>
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| : ❑ Rales
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| : ❑ Wheezing (suggestive of [[asthma]] or [[COPD]])
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| : ❑ Pleural rub ([[pleuritis]]
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| '''Abdominal examination'''<br>
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| ❑ Resonant percussion over the liver (suggestive of [[perforated peptic ulcer]])
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| ❑ [[Rectal examination]] that shows occult bleeding ([[peptic ulcer]])<br>
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| '''Neurological examination'''<br>
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| ❑ [[Cerebrovascular accident]]s ([[aortic dissection]])<br>
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| ❑ [[Paraplegia]]</div> }}
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| {{familytree | | | | | | | |!| | | }}
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| {{familytree | | | | | | | G01 | | G01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Order labs and tests:''' <br> ❑ [[EKG]] ''(most important initial test)'' <br> ❑ [[Cardiac enzymes]] ([[Troponin]], [[CK-MB]]<br> ❑ [[CBC]] <br> ❑ [[ABG]] <br> ❑ [[D-dimer]]
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| </div> }}
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| {{familytree | | | | | | | |!| | | }}
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| {{familytree | | | | | | | H01 | | H01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Order imaging studies:''' <br> ❑ [[Chest X-ray]] <br> ❑ [[Echocardiography]] </div> }}
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| {{familytree | | | | | | | |!| | | }}
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| {{familytree | | | | | | | U01 | | U01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Does the chest pain has any of the following findings suggestive of cardiac etiology?''' <br> ❑ <br> ❑ <br> ❑ <br> </div> }}
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| {{familytree | | | |,|-|-|-|^|-|-|-|.| | | }}
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| {{familytree | | | I01 | | | | | | I02 | | | I01= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''YES''' </div> | I02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''NO''' </div>}}
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| {{familytree | | | |!| | | | | | | |!| |}}
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| {{familytree | | | J01 | | | | | | J02 | | J01= <div style="float: left; text-align: left; width: 14em; padding:1em;">'''Click [[chest pain resident survival guide#Cardiac Chest Pain|here]] for the cardiac chest pain approach''' </div> | J02=<div style="float: left; text-align: left; width: 14em; padding:1em;">'''Click [[chest pain resident survival guide#Non-Cardiac Chest Pain|here]] for the non-cardiac chest pain approach''' </div> }}
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| {{familytree/end}}
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| ===Cardiac Chest Pain===
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| {{familytree/start}}
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| {{familytree | | | | | | | | A01 | | | | | | A01= <div style="float: left; text-align: left; width: 14em; padding:1em;">'''Does the EKG has ST elevation?''' </div>}}
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| {{familytree | | | |,|-|-|-|-|^|-|-|-|-|.| | | |}}
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| {{familytree | | | B01 | | | | | | | | B02 | | | | B01= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''YES''' </div> | B02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''NO''' </div>}}
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| {{familytree | | | |!| | | | | | | | | |!| | | | | |}}
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| {{familytree | | | C01 | | | | | | | | C02 | | | | |C01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''Is the ST elevation specific to an anatomic area?'''</div><div style="text-align: left"> ❑ V1-V2 (Septal) <br> ❑ V3-V4 (Anterior) <br> ❑ V5-V6 (Apical) <br> ❑ I, aVL (Lateral) <br> ❑ II, III, aVF (Inferior) </div> | C02= <div style="float: left; text-align: center; width: 14em; padding:1em;">'''Does the [[TTE]] shows valve or aortic abnormalities?''' </div> }}
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| {{familytree | |,|-|^|-|.| | | | | |,|-|^|-|.| | |}}
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| {{familytree | D01 | | D02 | | | | D03 | | D04 | | |D01=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''YES''' </div> | D02= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''NO''' </div>| D03=<div style="float: left; text-align: center; width: 16em; padding:1em;">'''YES''' </div> | D04= <div style="float: left; text-align: center; width: 16em; padding:1em;">'''NO''' </div>}}
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| {{familytree | |!| | | |!| | | | | |!| | | |!|| |}}
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| {{familytree | E01 | | E02 | | | | E03 | | E04 | |E01=<div style="float: left; text-align: left; width: 16em; padding:1em;">'''Consider the following:'''<br>
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| '''[[STEMI]]''' <br> ❑ Pain described as a heaviness or crushing sensation <br> ❑ Radiates to the left arm, neck and/or jaw <br> ❑ Not alleviated by rest or medications <br> ❑ CK-MB and Troponin elevation <br> ❑ PR depression is absent <br> [[STEMI resident survival guide|Click here for detailed management]]<br><br>
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| '''[[LBBB]]''' <br> ❑ EKG evidence of LBBB
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| : ❑ QRS ≥ 120 ms
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| : ❑ QS or rS in V1
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| : ❑ Monophasic R in I, aVL and V6
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| ❑ Chest pain with same characteristic as STEMI <br> [[STEMI resident survival guide|Click here for detailed management]]<br><br> </div> | E02= <div style="float: left; text-align: left; width: 16em; padding:1em;">'''Consider the following:'''<br> '''[[Pericarditis]]''' <br> ❑ Sharp and pleuritic pain that is improved by sitting up and leaning forward <br> ❑ Diffuse, non-specific ST elevation <br> ❑ PR depression <br> ❑ PR elevation in lead aVR <br> ❑ <br> ❑ <br> [[Pericarditis resident survival guide|Click here for detailed management]]<br><br> </div>| E03=<div style="float: left; text-align: left; width: 16em; padding:1em;">'''Consider the following:'''<br>
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| '''[[Aortic stenosis]]''' <br> ❑ Systolic ejection [[murmur]] with ejection click
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| : ❑ Best heard at the upper right sternal border
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| : ❑ Bilateral radiation to the [[carotid arteries]]
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| ❑ [[aortic stenosis echocardiography|TTE findings of AS]] <br> ❑ Exertional [[dyspnea]]<br> ❑ [[Syncope]] <br> [[Aortic stenosis resident survival guide|Click here for detailed management]] <br><br>
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| '''[[Aortic dissection]]''' <br> ❑ Acute onset of [[heart failure]] <br> ❑ Low pitched early diastolic murmur best heard at the 2nd right [[ICS]] <br> ❑ [[Widened mediastinum]] on [[chest X-ray]] <br> ❑ [[TTE]] findings of:
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| : ❑ Intimal tear
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| : ❑ [[Aortic regurgitation]]
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| ❑ History of:
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| : ❑ [[Hypertension]]
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| : ❑ [[Marfan syndrome]]
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| [[Aortic dissection resident survival guide|Click here for detailed management]]<br><br></div> |E04=<div style="float: left; text-align: left; width: 16em; padding:1em;">'''Consider the following:'''<br>'''[[Unstable angina]]/[[NSTEMI]]'''<br> ❑ Pain described as a heaviness or crushing sensation <br> ❑ Radiates to the left arm, neck and/or jaw <br> ❑ Not alleviated by rest or medications <br> ❑ Elevated [[cardiac enzymes]] <br> ❑ Pain last > 10 min <br> ❑ <br> [[NSTEMI angina resident survival guide|Click here for detailed management]]<br><br>
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| '''[[Stable angina]]''' <br> ❑ Normal [[cardiac enzymes]] <br> ❑ Pain usually lasts < 10 min <br> ❑ Improved by rest or [[nitroglycerin]] <br> [[Chronic stable angina treatment|Click here for detailed management]]<br><br></div>}}
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| {{familytree/end}}
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| ===Non-Cardiac Chest Pain===
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | A01 | | | | | | A01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Determine the non-cardiac etiology based on the physical examination and tests findings''' </div> }}
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| {{familytree | | | |,|-|-|-|-|-|-|+|-|-|-|-|-|.| |}}
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| {{familytree | | | K03 | | | | | K04 | | | | K05 | | | K03= <div style="float: left; text-align: center; width: 15em; padding:1em;">'''Pulmonary''' </div> | K04= <div style="float: left; text-align: center; width: 15em; padding:1em;">'''Gastrointestinal''' </div>| K05= <div style="float: left; text-align: center; width: 15em; padding:1em;">'''Other''' </div>}}
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| {{familytree | | | |!| | | | | | |!| | | | | |!| | |}}
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| {{familytree | | | F01 | | | | | F02 | | | | |!| | | F01=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Is the onset sudden?''' </div> |F02=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Is the onset sudden?''' </div> }}
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| {{familytree | |,|-|^|-|.| | | |,|^|-|.| | | |!| | |}}
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| {{familytree | A01 | | A02 | | A03| |A04 | |!| | | A01=<div style="float: left; text-align: center; width: 15em; padding:1em;">'''YES''' </div> | A02=<div style="float: left; text-align: center; width: 15em; padding:1em;">'''NO''' </div> | A03=<div style="float: left; text-align: center; width: 15em; padding:1em;">'''YES''' </div>| A04=<div style="float: left; text-align: center; width: 15em; padding:1em;">'''NO''' </div>}}
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| {{familytree | |!| | | |!| | | |!| | |!| | | |!| | | }}
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| {{familytree | L03 | | L04 | | L05| | L06| | L07 | | L03=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Consider the following:'''<br>
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| '''[[Pulmonary embolism]]''' <br> ❑ Sudden[[chest pain]] <br> ❑ Severe [[dyspnea]] <br> ❑ History of [[DVT]], [[surgery]], [[malignancy]], immobility <br> ❑ Elevated [[D-dimer]] <br>[[Pulmonary embolism resident survival guide|Click here for detailed management]] <br><br>
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| '''[[Pneumothorax]]''' <br> ❑ [[Dyspnea]]<br> ❑ [[Hypoxia]] <br> ❑ [[Tracheal deviation]] towards the unaffected side<br> ❑ [[percussion|Hyperresonance]] on the affected side <br> [[Tension pneumothorax resident survival guide|Click here for detailed management]]<br><br>
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| '''[[Asthma|Asthma exacerbation]]''' <br> ❑ Acute [[shortness of breath]] <br> ❑ [[Wheezing]] <br> ❑ History of [[asthma]] <br> [[Asthma exacerbation resident survival guide|Click here for detailed management]] <br><br></div>
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| | L04=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Consider the following:'''
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| <br> '''[[Pulmonary hypertension]]''' <br> ❑ [[Dyspnea]] on exertion <br> ❑ Increased [[P2]] <br> ❑ [[JVD]] <br> ❑ Lower extremity [[edema]] <br> ❑ History of gradual onset of [[shortness of breath]] <br>[[Pulmonary hypertension resident survival guide|Click here for detailed management]]<br><br>
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| '''[[Pneumonia]]''' <br> ❑ [[Productive cough]] <br> ❑ [[Fever]] <br> ❑ [[Dyspnea]]<br> ❑ New infiltrate on the [[CXR]] <br> [[Pneumonia medical therapy|Click here for detailed management]]<br><br>
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| '''[[Pleuritis]]''' <br> ❑ Sharp pain associated with [[inspiration]] and [[expiration]] <br> ❑ <br> ❑ <br> [[Pleurisy medical therapy|Click here for detailed management]]<br><br></div>
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| | L05=<div style="float: left; text-align: left; width: 15em; padding:1em;">'''Consider the following:''' <br>
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| '''[[Pancreatitis]]''' <br> ❑ Severe epigastric pain radiating to the back <br> ❑ [[Nausea]] and [[vomiting]] <br> ❑ Increased levels of [[amilase]] or [[lipase]]<br> ❑ History of [[alcohol intake]] or [[gallstones]] <br> [[Pancreatits resident survival guide|Click here for detailed management]]<br><br>
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| '''[[Acute cholecystitis]]''' <br> ❑ RUQ pain associated with meals <br> ❑ Positive [[Murphy sign]] <br> ❑ Nausea and vomiting <br> ❑ <br> [[Acute cholecystitis resident survival guide|Click here for detailed management]]<br><br></div>
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| | L06= <div style="float: left; text-align: left; width: 15em; padding:1em;">'''Consider the following:'''<br>
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| '''[[GERD]]''' <br> ❑ Burning sensation from the [[epigastrium]] towards the throat <br> ❑ After meals <br> ❑ Duration: minutes to hours <br> [[GERD resident survival guide|Click here for detailed management]] <br><br>
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| '''[[Peptic ulcer]]''' <br> ❑ Epigastric pain:
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| : ❑ Starts 5-15 min after a meal (suggestive of [[gastric ulcer]])
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| : ❑ Alleviated by meals (suggestive of [[duodenal ulcer]])
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| ❑ Alleviated by antacids <br> ❑ <br> [[Peptic ulcer resident survival guide|Click here for detailed management]]<br><br>
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| '''[[Esophageal spasm]]''' <br> ❑ Vomiting <br> ❑ Intermittent lower chest pain <br> ❑ Cervical [[subcutaneous emphysema]] <br> ❑ [[Alcoholism|Alcohol excess]] <br> ❑ <br> [[Nutcracker esophagus medical therapy|Click here for detailed management]]<br><br>
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| '''[[Mallory-Weiss]]''' <br> ❑ Epigastric ± back pain<br> ❑ History of [[vomiting]]<br> ❑ [[Hematemesis]] <br> [[Esopagheal spasm resident survival guide|Click here for detailed management]]<br><br></div>
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| | L07= <div style="float: left; text-align: left; width: 15em; padding:1em;">'''Consider the following:'''<br>
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| '''[[costochondritis|Musculoskeletal pain]]''' <br> ❑ Localized pain <br> ❑ Pain on palpation of [[costochondral joint]]s <br> ❑ Exacerbated by [[chest wall]] movements <br> ❑ History of [[RA]] <br>
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| '''[[Herpes zoster]]''' <br> ❑ Burning pain localized in a [[dermatome]] <br> ❑ Unilateral [[vesicular rash]] <br> ❑ History of [[immunodepresion]] or severe [[stress]]<br> [[Herpes zoster medical therapy|Click here for detailed management]] <br><br>
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| '''[[Psychiatric conditions]]''' <br> ❑ [[Depresion]]<br> ❑ [[Anxiety]] <br> ❑ [[Hypochondriasis]] <br> ❑ [[Panic attack]]<br> [[Click here for detailed management]]<br><br></div>}}
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| {{familytree/end}}
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| ==Treatment==
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| Shown below is an algorithm summarizing the therapeutic approach to chest pain based on the
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| <span style="font-size:85%">'''Abbreviations:''' </span>
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| ==Do's==
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| * <br>
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| *
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| ==Don'ts==
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| *
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| ==References==
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| {{Reflist|2}}
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| [[Category:Cardiology]]
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| [[Category:Resident survival guide]]
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| [[Category:Up-To-Date]]
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| [[Category:Emergency]]
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