278160
Description
Chest pain
- Differential diagnosis
- Aged over 60
- ACS & Stable angina
- PE
- Pleurisy secondary to infection
- Oesophagitis secondary to GORD/hiatus hernia
- Anxiety
- Px
- Boerhaave's perforation of OPS
- Cholcystitis/pancreatitis
- Aortic aneurysm
- ACS & Stable angina
- Younger pt
- ACS & Stable angina
- Myopericarditis( usually post-infarction)
- Aortic dissection
- Aortic aneurysm
- ACS & Stable angina
- Younger female on COC pill
- PE
- Px( esp if tall and thin)
- Cocaine induced spasm( rare)
- PE
- Aged over 60
- Immediate assessment
- Assess ABC
- Reassure the pt
- Allow pt to sit/lie in whatever
position is most comfortable
- Obtain a 12 lead
ECG
immediately(within
5-10 mins of arrival)
- High conc of oxygen by mask if
oxygen sat is < 94% on air
- Connect pt to monitoring devices( ECG,BP, sats)
- Venous access and blds for routine tests. Samples for
cardiac markers( usually 12 h after the onset of pain for
troponins)
- Request an urgent CXR/ consider need for early analgesia
- Assess ABC
- Hx
- SOCRATES for pain
- SOCRATES for pain
- Physical Exam
- Pallor, sweating/cyanosis
- Abnormal pulse/BP
- Raised JVP/oedema
- Added heart sounds
- Changed resp rate and pattern
- Low sats
- Reduced air entry and
abnormal breath sounds
- Abdo tenderness-esp epigastric and
renal pain( which may mimic chest
pain) and hepatic discomfort( CCF)
- Pallor, sweating/cyanosis
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