approach to chest pain |

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

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

G: ABDOMINAL

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

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