Chest pain resident survival guide (pediatrics): Difference between revisions
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* Quickly evaluate [[cardiac]] examination in [[pediatrics]] presented with [[chest pain]] and [[syncope]]. | * Quickly evaluate [[cardiac]] examination in [[pediatrics]] presented with [[chest pain]] and [[syncope]]. | ||
* [[ Arrhythmia]] leading [[chest pain]] in [[children]] include: [[paroxismal supraventricular tachycardia]] ([[PSVT]]), [[premature ventricular contraction]] ([[PVC]]), [[atrial flutter]], [[mobitz type2 block]] ,[[atrial tachycardia]], [[atrial premature contraction]]. | * [[ Arrhythmia]] leading [[chest pain]] in [[children]] include: [[paroxismal supraventricular tachycardia]] ([[PSVT]]), [[premature ventricular contraction]] ([[PVC]]), [[atrial flutter]], [[mobitz type2 block]] ,[[atrial tachycardia]], [[atrial premature contraction]]. | ||
* Think about [[pneumothorax]] among young adult [[male]] presented with [[tachypnea]], persistent [[pleutitic chest pain]] for 1-2 days and take a [[chest-X-ray]] for evaluation of [[air leak syndrome]]. | |||
* If the [[CXR]] is undiagnostic for evaluation of pneumomediustinum, [[chest]] CT-scan is considerede. | |||
==Don'ts== | ==Don'ts== |
Revision as of 14:48, 18 February 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Synonyms and keywords:
Chest pain resident survival guide (pediatrics) Microchapters |
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Overview |
Causes |
FIRE |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
- Cardiac causes such as life-threatening arrhythmia, acute coronary disease, acute pulmonary embolism, tamponade
- Abdominal aorta dissection with propagation to thoracic aorta
- Perforated peptic ulcer
- Air leak syndrome such as Pneunomothorax, pneumomediastinum
Common Causes
FIRE: Focused Initial Rapid Evaluation
Complete Diagnostic Approach
Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.
Charactristics of chest pain | |
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Musculoscletal origin | |
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Respiratory origin |
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Gastrointestinal origin |
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Cardiac origin | |
Psychogenic origin | |
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Ideopathic |
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Sharp | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dull | Undefined | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Duration of chest pain | Charactristics of chest pain | Associated symptoms | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Chest wall tenderness | Respiratory related | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Squeezing | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Symptoms associated with Chest pain in children and adolescence: ❑ Cough (23.4%) ❑ Dyspnea (11%) ❑ Abdominal pain (9.7%) ❑ Palpitation (9.7%) ❑ Respiratory related (9%) ❑ Dizziness (5.8%) ❑ Post nasal drip (4.4%) ❑ Fever (5.2%) ❑ Exercise induced (2.6%) ❑ Syncope (2.6%) | |||||||||||||||||||||
Cardiac | Underlying congenital or acquired heart disease, arrhythmia, crushing sternal chest pain, exercised induced chest pain, persistent tachycardia, hypotension, gallop rhythm, syncope | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pulmonary | Hemoptysia, dyspnea, rales,cyanosis | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Physical examination | Gastrointestinal | Hematemesis,hematochezia, melena | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Other | Febrile, psychosis, suisidal ideation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Evaluation of chest pain | |||||||||||||||||||||||||||||||||||||||||||||
Medical history, cardiac examination | |||||||||||||||||||||||||||||||||||||||||||||
Abnormal history or cardiac examination | Normal history and cardiac examination | ||||||||||||||||||||||||||||||||||||||||||||
Yes | NO | ||||||||||||||||||||||||||||||||||||||||||||
Febrile, acute onset symptoms | Palpitation, chest pain, positive family history | ||||||||||||||||||||||||||||||||||||||||||||
Yes | NO | NO | Yes | ||||||||||||||||||||||||||||||||||||||||||
Refer to pediatric cardiologist | At rest chest pain, exersional chest pain | Refer to pediatric cardiologist | |||||||||||||||||||||||||||||||||||||||||||
Exertional chest pain | At rest chest pain or reproducible on exam | ||||||||||||||||||||||||||||||||||||||||||||
Suspected asthma | Low likehood of cardiac chest pain | ||||||||||||||||||||||||||||||||||||||||||||
Yes | NO | Reassurance | |||||||||||||||||||||||||||||||||||||||||||
Bronchodilator | Refer to pediatric cardiologist | ||||||||||||||||||||||||||||||||||||||||||||
Improvement | |||||||||||||||||||||||||||||||||||||||||||||
Keeping management | Refer to pediatric cardiologist | ||||||||||||||||||||||||||||||||||||||||||||
Causes of sharp chest pain |
Aspect |
Ideopathic (73.6%) |
|
Respiratory (9.3%) | |
Musculoskeletal (8.8%) | |
Cardiac (3.8%) | |
Gastrointestinal (2.9%) | |
Psychiatric (1.4%) |
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
- Quickly evaluate cardiac examination in pediatrics presented with chest pain and syncope.
- Arrhythmia leading chest pain in children include: paroxismal supraventricular tachycardia (PSVT), premature ventricular contraction (PVC), atrial flutter, mobitz type2 block ,atrial tachycardia, atrial premature contraction.
- Think about pneumothorax among young adult male presented with tachypnea, persistent pleutitic chest pain for 1-2 days and take a chest-X-ray for evaluation of air leak syndrome.
- If the CXR is undiagnostic for evaluation of pneumomediustinum, chest CT-scan is considerede.
Don'ts
- The content in this section is in bullet points.