Chest pain resident survival guide: Difference between revisions
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{{familytree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | C01= [[STEMI]]| C02= [[Pericarditis]] | C03= [[LBBB]]| C04= [[Aortic dissection]]| C05= [[Pulmonary embolism]]| C06= [[Tension pneumothorax]]| C07= [[Esophageal rupture]]}} | {{familytree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | C01= [[STEMI]]| C02= [[Pericarditis]] | C03= [[LBBB]]| C04= [[Aortic dissection]]| C05= [[Pulmonary embolism]]| C06= [[Tension pneumothorax]]| C07= [[Esophageal rupture]]}} | ||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | ||
{{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | D01= | D02= | D03= | D04= | D05= | D06= | D07= }} | {{familytree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | ||
| D01= '''Look for supportive signs and symptoms:''' <br> | |||
* The pain is described as a heaviness or crushing sensation <br> | |||
* Pain radiating to the left arm <br> | |||
* Elbow pain <br> | |||
* Shortness of breath or dyspnea <br> | |||
* Nausea and vomiting <br> | |||
* Diaphoresis <br> | |||
* An elevation of the CK MB enzyme <br> | |||
* An elevation of the troponin enzyme <br> | |||
* An elevation of the myoglobin | |||
| D02= '''Look for supportive signs and symptoms:''' <br> | |||
* Pleuritic pain <br> | |||
* Chest pain that is positional <br> | |||
* A viral syndrome <br> | |||
* Fever <br> | |||
* Cough <br> | |||
* A pericardial rub <br> | |||
* The presence of tamponade <br> | |||
| D03= '''Look for supportive signs and symptoms:''' <br> | |||
* The pain is described as a heaviness or crushing sensation | |||
* Pain radiating to the left arm | |||
* Elbow pain | |||
* Shortness of breath or dyspnea | |||
* Nausea and vomiting | |||
* Diaphoresis | |||
* An elevation of the CK MB enzyme | |||
* An elevation of the troponin enzyme | |||
* An elevation of the myoglobin | |||
| D04= | D05= | D06= | D07= }} | |||
{{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| }} | {{familytree | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| }} | ||
{{familytree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | E01= | E02= | E03= | E04= | E05= | E06= | E07= }} | {{familytree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | E01= | E02= | E03= | E04= | E05= | E06= | E07= }} |
Revision as of 16:17, 28 February 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Definition
Chest pain is discomfort or pain that is felt anywhere along the front of the body between the neck and the upper abdomen.
Causes
Life-Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
- Aortic dissection
- Myocardial infarction
- Pericardial tamponade
- Pneumothorax
- Pulmonary embolism
- Unstable angina
Common Causes
- Biliary colic
- Costochondritis
- Cocaine induced coronary vasospasm
- Esophageal spasm
- GERD
- Myocardial infarction
- Panic attacks
- Pneumonia
- Stable angina
Management
Please find below an algorithm that summarizes the approach to chest pain.
Assess EKG | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Presence of ST elevation | Absence of ST elevation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ Rule out life threatening conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Does the patient have both of the following: ❑ There is ST elevation in a limited number of leads that fits the anatomic distribution of a coronary artery (examples would include but are not limited to leads 2,3,F, or Leads v1-v4) | Does the patient have any of the following: ❑ There is ST elevation in multiple leads that does not follow an anatomic distribution of coronary arteries (ST elevation is diffuse) | ❑ Evidence of LBBB | |||||||||||||||||||||||||||||||||||||||||||||||||||||
STEMI | Pericarditis | LBBB | Aortic dissection | Pulmonary embolism | Tension pneumothorax | Esophageal rupture | |||||||||||||||||||||||||||||||||||||||||||||||||
Look for supportive signs and symptoms:
| Look for supportive signs and symptoms: | Look for supportive signs and symptoms: | |||||||||||||||||||||||||||||||||||||||||||||||||||||