Sandbox/AL: Difference between revisions
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{{familytree | | | | | | | H01 | | H01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Order imaging studies:'''<br> ❑ | {{familytree | | | | | | | H01 | | H01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Order imaging studies:'''<br> ❑ [[EKG]] <br> ❑ [[Chest X-ray]] <br> ❑ [[Echocardiography]] </div> }} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | U01 | | U01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Does the chest pain has any of the following findings suggestive of cardiac etiology?''' <br> ❑ <br> ❑ <br> ❑ <br> </div> }} | {{familytree | | | | | | | U01 | | U01= <div style="float: left; text-align: left; width: 20em; padding:1em;">'''Does the chest pain has any of the following findings suggestive of cardiac etiology?''' <br> ❑ <br> ❑ <br> ❑ <br> </div> }} | ||
{{familytree | | | |,|-|-|-|^|-|-|-|.| | | }} | {{familytree | | | |,|-|-|-|^|-|-|-|.| | | }} | ||
{{familytree | | | I01 | | | | | | I02 | | | I01= <div style="float: left; text-align: center; width: | {{familytree | | | I01 | | | | | | I02 | | | I01= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''YES''' </div> | I02= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''NO''' </div>}} | ||
{{familytree | | | |!| | | | | | | |!| |}} | {{familytree | | | |!| | | | | | | |!| |}} | ||
{{familytree | | | J01 | | | | | | J02 | | J01= <div style="float: left; text-align: left; width: | {{familytree | | | J01 | | | | | | J02 | | J01= <div style="float: left; text-align: left; width: 12em; padding:1em;">'''Does the EKG has ST elevation?''' </div> | J02=<div style="float: left; text-align: left; width: 10em; padding:1em;">'''Determine the non-cardiac etiology based on the physical examination and tests findings''' </div> }} | ||
{{familytree | |,|-|^|-|.| | |,|-|-|^|v|-|-|-|.| | }} | {{familytree | |,|-|^|-|.| | |,|-|-|^|v|-|-|-|.| | }} | ||
{{familytree | K01 | |K02| | K03 | | K04 | | K05| | |K01= <div style="float: left; text-align: center; width: | {{familytree | K01 | |K02| | K03 | | K04 | | K05| | |K01= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''YES''' </div> | K02= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''NO''' </div>| K03= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''Pulmonary''' </div> | K04= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''Gastrointestinal''' </div>| K05= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''Other''' </div>}} | ||
{{familytree | |!| | | |!| | |!| | | |!| | | |!| | |}} | |||
{{familytree | L01 | |L02| | L03 | | L04 | | L05 | |L01= <div style="float: left; text-align: left; width: 12em; padding:1em;">'''Consider the following:'''<br> | |||
'''[[STEMI]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[STEMI resident survival guide]]<br> | |||
'''[[LBBB]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[STEMI resident survival guide]]<br> | |||
'''[[Pericarditis]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Pericarditis resident survival guide]]<br></div> | |||
| L02= <div style="float: left; text-align: left; width: 12em; padding:1em;">'''Consider the following:'''<br> | |||
'''[[Aortic stenosis]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Aortic stenosis resident survival guide]] <br> | |||
'''[[Aortic dissection]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Aortic dissection resident survival guide]]<br> | |||
'''[[Stable angina]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Stable angina resident survival guide]]<br></div> | |||
| L03=<div style="float: left; text-align: left; width: 12em; padding:1em;">'''Consider the following:'''<br> | |||
'''[[Pulmonary embolism]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Pulmonary embolism resident survival guide]] <br> | |||
'''[[Spontaneous pneumothorax]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Spontaneous pneumothorax resident survival guide]]<br> | |||
'''[[Pulmonary hypertension]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Pulmonary hypertension resident survival guide]]<br> | |||
'''[[Pleuritis]]''' <br> ❑ <br> ❑ <br> ❑ <br> Click here for [[Pleuritis resident survival guide]]<br></div> | |||
| L04= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''Gastrointestinal''' </div>| L05= <div style="float: left; text-align: center; width: 12em; padding:1em;">'''Other''' </div>}} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 13:31, 25 April 2014
Overview
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 red 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 ❑ Altered mental status ❑ Severe dyspnea ❑ Oliguria ❑ Cold extremities | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Initiate resuscitation measures: ❑ Secure airway ❑ Administer oxygen ❑ Secure wide bore IV access ❑ Perform ECG monitor ❑ Monitor vitals continuously ❑ Immediately order an ECG | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
ECG findings | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Presence of ST elevation | Absence of ST elevation | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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) | ❑ Evidence of LBBB | 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) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
STEMI | LBBB | Pericarditis | Angina | Aortic dissection | Pulmonary embolism | Tension pneumothorax | Esophageal rupture | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Look for supportive signs and symptoms: ❑ The pain is described as a heaviness or crushing sensation | Look for supportive signs and symptoms: ❑ The pain is described as a heaviness or crushing sensation | Look for supportive signs and symptoms: ❑ Pleuritic pain | Look for supportive signs and symptoms: ❑ | Look for supportive signs and symptoms: ❑ Back pain
| Look for supportive signs and symptoms: ❑ Shortness of breath | Look for supportive signs and symptoms: ❑ Sudden shortness of breath | Look for supportive signs and symptoms: ❑ Vomiting | {{{ }}} | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | Angina | Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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 chest pain: ❑ Heaviness or crushing sensation (suggestive of myocardial isquemia)
❑ | |||||||||||||||||||||||||||||||||||||||||
Characterize the associated symptoms: ❑ Altered mental status ❑ ❑ ❑ ❑ ❑ | |||||||||||||||||||||||||||||||||||||||||
Inquire about past medical history: ❑ Previous episodes | |||||||||||||||||||||||||||||||||||||||||
Identify possible triggers: | |||||||||||||||||||||||||||||||||||||||||
Examine the patient:
Vitals
| |||||||||||||||||||||||||||||||||||||||||
Order labs and tests: ❑ EKG (most important initial test) ❑ Electrolytes
❑ Glucose (rule out hypoglycemia) | |||||||||||||||||||||||||||||||||||||||||
Does the chest pain has any of the following findings suggestive of cardiac etiology? ❑ ❑ ❑ | |||||||||||||||||||||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||||||||||||||||||||
Does the EKG has ST elevation? | Determine the non-cardiac etiology based on the physical examination and tests findings | ||||||||||||||||||||||||||||||||||||||||
YES | NO | Pulmonary | Gastrointestinal | Other | |||||||||||||||||||||||||||||||||||||
Consider the following: STEMI LBBB ❑ ❑ ❑ Click here for Pericarditis resident survival guide | Consider the following: Aortic stenosis Aortic dissection ❑ ❑ ❑ Click here for Stable angina resident survival guide | Consider the following: Pulmonary embolism Spontaneous pneumothorax Pulmonary hypertension ❑ ❑ ❑ Click here for Pleuritis resident survival guide | Gastrointestinal | Other | |||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the therapeutic approach to chest pain based on the
Abbreviations: