chestpain how to treat edited

8/8/2019 Chestpain How to Treat Edited

1/45

Approach to Chest Pain

In theEmergency Department


2/45

1.Approach to chest pain

2. Acute MI and ACS

3. Non-cardiac chest pain


3/45

CHEST PAIN

Acute MI Herpes Zoster Aortic dissection Mitral valve prolapse

Bronchitis Perforated ulcer

Chest wall strain Pericarditis

Cholescystitis Pleural effusion

Cocaine induced coronary spasm PleurisyCoronary aneuysm Pneumonia

Costochondritis Pneumothorax

Crescendo angina/acute coronary syndrome Precordial catch syndrome

Esophageal rupture Pulmonary embolism

Esophageal spasm Sickle cell disease

Faceteous Stable angina

Fracture t-spine Thoracic HNP

Fractured rib Thoracic outlet syndrome

Gastric reflux Tietze's syndrome


4/45

CHEST PAIN

Acute MI Herpes ZosterAortic dissection Mitral valve prolapse














5/45

CHEST PAIN

Acute MI Herpes ZosterAortic dissection Mitral valve prolapse














6/45

of what we learn

in medical school iswrong


7/45

Unfortunately, we do

not know which half it

is.


8/45

Approach to Chest Pain

In theEmergency Department


9/45

Eye what to think


10/45

Think of the killers firstBy age group


11/45

Young:

PE

Aortic Dissection

Pneumothorax

PericarditisCocaine


12/45

Older:

Mi

PEPneumonia

Pneumothorax

Aortic aneurysm


13/45

#1 cause of life loss in the E.D:

MI to PE


14/45

Esophageal rupture

In a vomiter


15/45

1.Vital signs2.How does the person look ?


16/45

1.O

2 sat2. ECG


17/45

1.Physical exam

2. CXR

3.Enzymes


18/45

Favor observation


19/45

AMI w/o chest pain:

1.Syncope

2.Epigastric pain


20/45

The send homes:


21/45

Precordial catch syndrome

Pleurisy

BronchitisMusculoskeletal pain

Costochondritis


22/45

The ICU/CCUs:


23/45

1.Acute MI

2.PE

3.Tension pnemothorax4. Dissection

5.Pneumonia in

respiratory distress


24/45

The teles:


25/45

1.Possible cardiac chest pain

2.Epigastric painwith risk factors


26/45

The admits to MU:


27/45

1.Equivocal diagnosis

2.Non-tension pneumothorax

3.Pneumonia with

variable O2 sat

4.Possible P

.E.


28/45

D-dimer


29/45

D-dimer questionable


30/45

If negative,

great, ifpositive, then

what?


31/45

Do CT or Scan


32/45

Lung Scan:


33/45

This probably represents a

Low probability of a p.e.

But could represent anintermediate probability

of a p.e.


34/45


35/45

No good answers


36/45

1.Lung scan?

2. CT SCAN with shield?3.D-dimer and sonos?


37/45

Informed consent


38/45

Take everypatient seriously


39/45

ECG even on the young:

?pericarditis??cocaine?

?coronary artery aneurysm?


40/45

Enzymes:

?why myoglobin and troponin?


41/45

Chest xray:

CT scan if wide mediastinum!!!


42/45

You are

sending homeIHD patients


43/45

Chest Pain ER;

4,000 caths ayear


44/45

The ECG is

outmodedand

outdated


45/45

Future:

AMI, ACS, P.E., Aortic Dissection,

Esophageal Rupture, Pneumothoraxand Ruptured Aortic Aneurysm

chestpain how to treat edited

Documents