Chest Pain
On Call: Chest Pain
Table of Contents
Differential Diagnosis
Primary Concerns (Immediate Threat to Life)
- Myocardial Infarction (MI)
- Pulmonary Embolism (PE)
- Aortic Dissection
- Tension Pneumothorax
- Pericardial Tamponade
Secondary Concerns
- Musculoskeletal:
- Costochondritis
- Trauma/Rib Fracture
- Postoperative Pain
- Cardiac:
- Pericarditis
- Congestive Heart Failure
- Pulmonary:
- Pneumonia
- Pleural Effusion
- GI:
- Esophageal Reflux
- Esophagitis
- Peptic Ulcer Disease
- Symptomatic Cholelithiasis
- Cholecystitis
Particular Concerns for History & Physical
Vitals
- ABC’s – Airway, Breathing, and Circulation
- Vital Signs
Subjective
- Description of Pain (O-P-Q-R-S-T)
- Onset
- Provoking Factors
- Quality (Pressure, Sharp, Pleuritic)
- Radiation (Shoulder, Jaw, Back)
- Site of Pain
- Timing (Constant, Intermittent)
- Shortness of Breath
- Associated Factors
History
- History of Cardiac Disease
- History of Reflux
- Surgical History
Physical Exam
- Chest Rise
- Heart/Lung Auscultation
- Jugular Venous Distention
- Abdominal Pain
- Abdominal Distention
Work Up & Management
Always Start with ABC’s – Airway, Breathing, and Circulation
Initial Orders
- EKG
- Chest X-Ray
- Troponin
Other Potential Orders
- Arterial Blood Gas (ABG)
- Other Labs (CBC, CMP, BNP)
- CT Chest
- CT Abdomen/Pelvis
- CTA Chest
- CT Pulmonary Angiogram
Further Management
- Dictated by Findings and Diagnosis
- Myocardial Infarction (MI)
- Pulmonary Embolism (PE)