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