Sandbox/AL

FIRE: Focused Initial Rapid Evaluation

A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.

Boxes in the salmon color signify that an urgent management is needed.

Abbreviations:

Identify cardinal findings that increase the pretest probability of life-threatening chest pain ❑

Does the patient have any of the findings that require urgent management? ❑ Tachycardia ❑ Hypotension ❑ Severe dyspnea ❑ ❑

Yes

No

Initiate resuscitation measures: ❑ Secure airway ❑ Administer oxygen ❑ Secure wide bore IV access ❑ Perform ECG monitor ❑ Monitor vitals continuously ❑ Immediately order an ECG

Continue with the complete diagnostic approach below

ECG findings

Complete Diagnostic Approach

A complete diagnostic approach should be carried out after a focused initial rapid evaluation is conducted and following initiation of any urgent intervention.

Abbreviations:

Characterize the symptoms: ❑ ❑ ❑ ❑ ❑ Activity prior to ❑

Inquire about past medical history: ❑ Previous episodes ❑ Cardiovascular disease ❑ Neurological diseases

Identify possible triggers:

Examine the patient: Vitals ❑ Heart rate ❑ Blood pressure ❑ Respiratory rate Cardiovascular Respiratory ❑ Rales (suggestive of HF) Neurologic

Order labs and tests: ❑ EKG (most important initial test) ❑ Electrolytes ❑ Glucose (rule out hypoglycemia) ❑ ABG

Order imaging studies: ❑ Echocardiography

Treatment

Shown below is an algorithm summarizing the therapeutic approach to chest pain based on the

Abbreviations:

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References

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