approach to chest pain

chestpain

Chest pain is a common presentation to the ER with high medico-legal consequences

Here’s an approach that starts with a broad differential for your history, physical, bedside ultrasound and ECG, after which you can generate a pre-test likelihood for tests and treatment

A

  • foreign body aspiration

B: CHEST

  • Collapse: pneumothorax
  • Hyperinflate: asthma/COPD
  • E
  • Sick pneumonia
  • Tumour

C: CARDIOVASCULAR

  • Cardiac arrythmia
  • Around heart; pericarditis
  • RV strain: PE
  • Dysfuctional LV: MI
  • Incompetent valve, eg mitral valve prolapse
  • Outflow: dissection

D

E

F

G: ABDOMINAL

  • Ascites: hepatitis
  • Biliary: chole
  • Dyspepsia: esophageal rupture, PUD
  • Organomegaly: splenic injury

H

I: INTOX

  • cocaine

Joint/skin/bone:

  • zoster
  • costochondritis

 

Putting this together:

  • A: assess airway
  • B: give oxygen, ultrasound for loss lung slide/effusion/consolidation/mass; CXR
  • C: ECG for pericarditis/ACS/PE, ultrasound for RV strain/effusion/LV dysfuction, consider CT chest for PE/dissection
  • D
  • E
  • F
  • G: assess abdomen
  • H
  • I: consider cocaine
  • J: look/feel skin

chestpain

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