Chest & Abd Pain Flashcards
Thoracic chest pain DDX
Cardiac: CAD (angina, MI), Pericarditis, Pulmonary HTN, PE, Aortic dissection, mitral valve prolapse, Myocarditis
Non-Cardiac: MSK, GERD, Esophageal disorder, Lung disease, Pleural disease, gall bladder disease, anxiety
How is pleuritic pain described?
Pain is increased by deep breathing, coughing, etc…
Pleuritic chest pain DDX
PE, Pneumothorax, Pneumonia, Pleurisy
Possible causes of chest wall (somatic) pain
Intercostal Strain, Costochondritis, Herpes Zoster
sudden, very intense tearing pain =
aortic dissection
Becks triad
for cardiac tamponade = hypotension, JVD, muffled heart sounds
Essential workup for chest pain
EKG
CXR
Troponin (does not r/o AMI if taken w/i 12 hrs)
Acute coronary syndrome and acute MI treatment
MONA (BB if tachycardic or hypertensive)
Goal is reperfusion (fibrinolysis less than 12 hrs)
Cardiac tamponade treatment
Pericardiocentesis (just below xyphoid aiming for left shoulder at 45 degrees)
Pulmonary embolism treatment
Stable: LMWH (Enoxaparin 1mg/kg subQ)
Unstable: Thrombolysis (Alteplase 100mg over 2hrs)
Aortic dissection treatment
Initial: Central Line, Morphine for pain, fluids for hypotension
Stable: Propranolol, Diltiazem, Enalapril (heart, vessels, BP)
Unstable: Surgery
Esophageal Spasm/Rupture treatment
Spasm: GI cocktail, nitro
Rupture: Airway, Fluids, Surgery
Pericarditis treatment
NSAIDs, Colchicine (70-90% self limited)
Pneumothorax (Tension) treatment
Severe/Unstable: needle decompression (14-guage 2nd intercostal MCL)
Definitive Tx: chest tube thoracotomy (36-French 4th intercostal AAL)
dyspnea vs respiratory distress
dyspnea is subjective
respiratory distress is objective (hypoxia, tachypnea, cyanosis, etc.)
Red flags of dyspnea
- decreased mental status (anxiety-lethargy)
- labored breathing (tachypnea/accessory muscle use)
- speaking in fragmented sentences
- Cyanosis
Life threatening dyspnea
Upper airway obstruction (FB, angioedema, hemorrhage)
Tension pneumothorax
PE
Essential workup for dyspnea?
chest XR!!!
pulse ox, ABG, EKG
s/s: moist crackles, JVD, pedal edema, S3 heart sound, pink/frothy sputum
CHF exacerbation or pulmonary edema
triggers: pulm infection, allergens
s/s: wheezing, poor air movement, coughing
asthma or COPD exacerbation
Triggers: foreign body, infection (epiglottitis), hypersensitive reaction (angioedema)
s/s: stridor, drooling, hoarseness, swelling
upper airway obstruction
Triggers: viral URI, influenza, hx of respiratory problems
s/s: cough, fever, pleuritic chest pain
pneumonia
Triggers: hx of PE/DVT, smoking, OCP use, cancer, immobilization, recent trauma
s/s: dyspnea, tachypnea, tachycardia, hemoptysis
pulmonary embolism
Triggers: young, tall, male, smoker
s/s: pleuritic chest pain, uneven chest rise/breath sounds, tracheal shift
pneumothorax
Goals for oxygen level in dyspnea patient
greater than 90%
Initial treatment for all dyspnea patients
facemask with 100% oxygen
caution if COPD
Labs for dyspnea workup
CBC, BMP, BNP, D-dimer, sputum/blood culture, tox screen
How is a pneumothorax managed?
Observe if less than 15%
Tube thoracotomy if over 15-20% or enlarging on repeat CXR
________ refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hrs in duration.
acute abdomen
What type of abdominal pain tends to make patients want to move around? type to make lie still?
visceral - move
parietal - lie still
Describe ischemic visceral abdominal pain
severe, diffuse, and disproportionate to exam
Which organ visceral pain is referred to umbilicus?
midgut
Which organ visceral pain is referred to superior of umbilicus?
foregut (liver, stomach)
How to test Murphy’s sign? Seen with what?
Pain with inspiration when pressure applied under right costal margin
gall bladder inflammation
McBurney’s Point pain indicates _________.
appendicitis
positive psoas sign indicates _________.
retrocecal appendicitis
________ sign indicates pelvic inflammation.
obturator
When to do a rectal exam with abdominal pain?
possible GI bleed, prostatitis, hemorrhoids or fissures
Why order lipase for abdominal pain?
evaluate pancreas
What patients with abdominal pain need urgent surgery?
acute, severe pain
pulsatile mass
shock sx’s
Common IV antiemetics
Zofran
Reglan
Common IV antibiotics for abdominal pain
Ancef
Zosyn
How to image renal stones?
CT without contrast
Signs of small bowel obstruction on XR
air-fluid levels and dilation
Signs of foreign bodies on XR
opacities
Signs of perforation on abdominal XR
free air under diaphragm
Admission criteria for abdominal pain
surgical intervention needed IV abx needed peritoneal signs unable to keep down fluids lack of pain control
Discharge criteria
No surgical or severe condition found
Able to keep down fluids
Good pain control
Able to follow discharge plan
Admission criteria for dyspnea
Requires assisted ventilation
Ongoing hypoxia
Requires ongoing treatment
colicky abdominal pain and spasm of smooth muscle comes from pathology where?
intestines, gall bladder