Tuesday, September 10, 2013

Evaluation of Chest Pain

            Chest pain is the chief complaint for 5% to 10% of all emergency department visits in the United States and  represents a wide spectrum of disease, from benign to life-threatening conditions. Consequently the initial evaluation must rapidly focus on ruling out the five most common life-threatening conditions that present with chest pain:

                    1. Acute Coronary Syndrome
                    2. Cardiac Tamponade
                    3. Aortic dissection
                    4. Pulmonary embolism
                    5. Tension penumothorax

            A five-step approach to accurate and rapid triage of patients with chest pain includes a focused history, a directed physical exam, an electrocardiogram (ECG) performed within 10 minutes of arrival, chest x-ray, and appropriate laboratory studies, general appearance should be assesed immediately to identify patients who are critically ill. patients who are pale, diaphoretic, anxious, and ill-appearing require immediate attention, including hemodynamic assesment, ECG, and chest x-ray. Hemodynamically unstable patients should be evaluated and stabilized per the advanced cardiac life support (ACLS) protocol.

               Particular emphasis should be placed on rapidly and accurately characterizing the current episode of chest pain. A rapid-fire set of questions following and alphabetical menmonic (OPQRSTUVW) can provide the framework for a focused, precise history. This method starts with the most importin triaging question of Ongoing chest pain and finishes with asking the patient about factors that make pain Worse or better. The remainder of a thorough history can be performed later.

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