Chest Pain Flashcards
Chest Pain
Critical (all systems):
MI
Tamponade
PNA
PTX
PE
Aortic dissection
Boerhaave’s
Chest Pain
Cardiac:
Angina (stable, unstable, Prinzmetal’s)
Cocaine
Pericarditis
Myocarditis
Endocarditis
MVP
AS
Hypertrophic CM
Acute CHF
Chest Pain
Pulmonary:
Empyema
Effusion
Pleuritis
Asthma
COPD
Bronchitis
Tracheitis
Aspirated FB
CA
Chest Pain
Vasc:
Aneurysm
SC crisis
Acute chest syndrome
Arthritis
Chest Pain
MSK:
Rib fx / contusion
Sternal fx
Septic SC joint or disloc
Costochondritis
Arthritis
Pec rupture
Muscle strain
Trauma
Thoracic degenerative disc disease
Chest Pain
Esophageal:
Mallory-Weiss tear
GERD
spasm
FB
Food impaction
CA
Chest Pain
GI:
Hiatal hernia
Diaphragm rupture,
PUD,
Perforated viscus,
Hepatitis,
Cholecystitis,
Biliary colic,
Pancreatitis,
FHC
Splenic infarct/distention
Chest Pain
Breast:
Mastitis
CA
Engorgement
Chest Pain
Neuropathic:
Zoster
Radiculopathy
Neuralgia
Chest Pain
Psych:
Anxiety/panic,
Somatoform DO
Chest Pain
ASAP:
ABCs, 2 LB IVs, O2, monitor, VS, EKG w/in 10 min
Chest Pain
Hx:
- Pain OPQRST,
- CAD risks (> 50 yo, HTN, DM, HL, FHx, smoking, cocaine)
- PE risks (recent surg/immob, estrogen meds/preg, cancer, prior clot, CA),
- CV and pulm path
- SAMPLE hx
Chest Pain
Exam:
JVD
trachea ML
M/R/G
W/R/C
decr BS
ttp
AAA
mass
hemoccult
edema
pulses
DVT
clubbing
diaphoresis
cyanosis
pallor
Chest Pain
Labs:
CBC
BUN/Cr
lytes
gluc
Trop/CK/MB
± BNP
± coags
± d-dimer
Chest Pain
Rads:
CXR, ± Echo, ± CT
Chest Pain
Add’l studies:
Serial ECGs
Bilateral Blood Pressures
Chest Pain
Life threats: Arrhythmia Treatment:
Meds vs Shock
Chest Pain
Life threats: Hypotension Treatment:
- IVF
- Dopamine 2-10 mcg/kg/min or Norepinephrine 2-10 mcg/min IV
- ± IABP/ cath
Chest Pain
Life threats: Pulm edema (CHF)Treatment:
BiPAP, Captopril 25 mg SL or Enalaprilat 0.625-1.25 mg IV, NTG 20-80 mcg/min IV or NTP 0.25-10 mcg/kg/min
IV, Lasix 20-80 mg IV, Dobutamine 2-10 mcg/kg/min IV (if low EF & SBP >100)
Chest Pain
Life threats: STEMI Treatment:
- ASA 4 x 81 mg
- Heparin 60u/kg IV then 12u/kg/hr IV (max 4000, 1000) or Lovenox 1mg/kg SC.
- Ask Cards: Plavix & GPIIb/IIIa?
- Adjuncts: O2, NTG, Metoprolol 5mg IV q 5 m x 3.
Chest Pain
Life threats: Aortic Dissection Treatment:
- 2 LB IVs
- T+C 4u PRBCs,
- Call CT/vasc or transfer.
- Goal HR 60-80:
- Esmolol 500 mcg/kg IV then 50-200 mcg/kg/min or Labetalol 0.25-1 mg/kg IV double q 10min (max 300mg total) then 1-2mg/min.
- Goal SBP 100-120: NTP.
Chest Pain
Life threats: PE Treatment:
- Heparin 80u/kg then 18u/kg/hr or Lovenox 1mg/kg SQ.
- Consider Lytics if in shock, severe resp distress, hypoxic, or RV dysfxn on echo.
Chest Pain
Life threats: Tamponade Treatment:
2 LB IV, ± Pericardiocentesis, CT surg
Chest Pain
Life threats: Tension PTX Treatment:
Off vent, Needle D, chest tube
