Sandbox/AL: Difference between revisions
Line 115: | Line 115: | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | A01 | | A01= <div style="float: left; text-align: left; width: | {{familytree | | | | | | | A01 | | A01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Characterize the chest pain:'''<br> | ||
'''Type''' | '''Type'''<br> | ||
❑ Heaviness or crushing sensation (suggestive of [[myocardial isquemia]]) <br> | ❑ Heaviness or crushing sensation (suggestive of [[myocardial isquemia]]) <br> | ||
❑ [[Pleuritic pain]] (suggestive of [[pericarditis]] or pulmonary etiology) | ❑ [[Pleuritic pain]] (suggestive of [[pericarditis]] or pulmonary etiology) | ||
Line 130: | Line 130: | ||
❑ Retrosternal (suggestive of cardiac etiology or esophageal spasm) <br> | ❑ Retrosternal (suggestive of cardiac etiology or esophageal spasm) <br> | ||
❑ Epigastric (suggestive of inferior MI or gastrointestinal etiology) <br> | ❑ Epigastric (suggestive of inferior MI or gastrointestinal etiology) <br> | ||
❑ Lateral chest wall (suggestive of pulmonary etiology) | ❑ Lateral chest wall (suggestive of pulmonary etiology)<br> | ||
'''Activity prior''' <br> | '''Activity prior''' <br> | ||
❑ </div>}} | ❑ </div>}} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | A01 | | A01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | A01 | | A01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''Characterize the associated symptoms:'''<br> | ||
❑ Altered mental status<br> | ❑ Altered mental status<br> | ||
❑ Shortness of breath <br> | ❑ Shortness of breath <br> | ||
Line 147: | Line 147: | ||
❑ <br> ❑ <br> ❑ <br> ❑ <br> ❑ <br> ❑ <br></div>}} | ❑ <br> ❑ <br> ❑ <br> ❑ <br> ❑ <br> ❑ <br></div>}} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | L01 | | L01= <div style="float: left; text-align: left; width: | {{familytree | | | | | | | L01 | | L01= <div style="float: left; text-align: left; width: 25em; padding:1em;"> '''Inquire about past medical history:'''<br> | ||
❑ Previous episodes<br> | ❑ Previous episodes<br> | ||
❑ Cardiovascular disease | ❑ Cardiovascular disease | ||
Line 155: | Line 155: | ||
❑ Alcohol intake </div> }} | ❑ Alcohol intake </div> }} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | B01 | | B01=<div style="float: left; text-align: left; width: | {{familytree | | | | | | | B01 | | B01=<div style="float: left; text-align: left; width: 25em; padding:1em;">'''Identify possible triggers:''' <br> | ||
</div>}} | </div>}} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | Z01 | | Z01= <div style="float: left; text-align: left; width: | {{familytree | | | | | | | Z01 | | Z01= <div style="float: left; text-align: left; width: 25em; padding:1em;"> '''Examine the patient:''' | ||
'''Vitals'''<br> | '''Vitals'''<br> | ||
❑ [[Heart rate]] | ❑ [[Heart rate]] | ||
Line 173: | Line 173: | ||
'''Neurologic'''<br></div> }} | '''Neurologic'''<br></div> }} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | G01 | | G01= <div style="float: left; text-align: left; width: | {{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> ❑ [[Electrolytes]] <br> ❑ [[Glucose]] (rule out [[hypoglycemia]]) <br> ❑ [[ABG]] | ||
</div> }} | </div> }} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | H01 | | H01= <div style="float: left; text-align: left; width: | {{familytree | | | | | | | H01 | | H01= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Order imaging studies:''' <br> ❑ [[Chest X-ray]] <br> ❑ [[Echocardiography]] </div> }} | ||
{{familytree | | | | | | | |!| | | }} | {{familytree | | | | | | | |!| | | }} | ||
{{familytree | | | | | | | U01 | | U01= <div style="float: left; text-align: left; width: | {{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> }} | ||
{{familytree | | | |,|-|-|-|^|-|-|-|.| | | }} | {{familytree | | | |,|-|-|-|^|-|-|-|.| | | }} | ||
{{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>}} | {{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>}} |
Revision as of 14:30, 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: Type
❑ Burning sensation (suggestive of gastrointestinal etiology) | |||||||||||||||||||||||||||||||||||||||||
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) ❑ ABG | |||||||||||||||||||||||||||||||||||||||||
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 ❑ ❑ ❑ Click here for detailed management | Consider the following: Aortic stenosis ❑ ❑ ❑ Click here for detailed management | Consider the following: Pulmonary embolism ❑ ❑ ❑ Click here for detailed management | Consider the following: GERD ❑ ❑ ❑ Click here for detailed management | Consider the following: Musculoskeletal pain ❑ ❑ ❑ Click here for detailed management | |||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the therapeutic approach to chest pain based on the
Abbreviations: