Chest Pain

Question 1

Chest Pain

Critical (all systems):

Answer 1

MI
Tamponade
PNA
PTX
PE
Aortic dissection
Boerhaave’s

Question 2

Chest Pain

Cardiac:

Answer 2

Angina (stable, unstable, Prinzmetal’s)
Cocaine
Pericarditis
Myocarditis
Endocarditis
MVP
AS
Hypertrophic CM
Acute CHF

Question 3

Chest Pain

Pulmonary:

Answer 3

Empyema
Effusion
Pleuritis
Asthma
COPD
Bronchitis
Tracheitis
Aspirated FB
CA

Question 4

Chest Pain

Vasc:

Answer 4

Aneurysm
SC crisis
Acute chest syndrome
Arthritis

Question 5

Chest Pain

MSK:

Answer 5

Rib fx / contusion
Sternal fx
Septic SC joint or disloc
Costochondritis
Arthritis
Pec rupture
Muscle strain
Trauma
Thoracic degenerative disc disease

Question 6

Chest Pain

Esophageal:

Answer 6

Mallory-Weiss tear
GERD
spasm
FB
Food impaction
CA

Question 7

Chest Pain

GI:

Answer 7

Hiatal hernia
Diaphragm rupture,
PUD,
Perforated viscus,
Hepatitis,
Cholecystitis,
Biliary colic,
Pancreatitis,
FHC
Splenic infarct/distention

Question 8

Chest Pain

Breast:

Answer 8

Mastitis
CA
Engorgement

Question 9

Chest Pain

Neuropathic:

Answer 9

Zoster
Radiculopathy
Neuralgia

Question 10

Chest Pain

Psych:

Answer 10

Anxiety/panic,
Somatoform DO

Question 11

Chest Pain

ASAP:

Answer 11

ABCs, 2 LB IVs, O2, monitor, VS, EKG w/in 10 min

Question 12

Chest Pain

Hx:

Answer 12

• 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

Question 13

Chest Pain

Exam:

Answer 13

JVD
trachea ML
M/R/G
W/R/C
decr BS
ttp
AAA
mass
hemoccult
edema
pulses
DVT
clubbing
diaphoresis
cyanosis
pallor

Question 14

Chest Pain

Labs:

Answer 14

CBC
BUN/Cr
lytes
gluc
Trop/CK/MB
± BNP
± coags
± d-dimer

Question 15

Chest Pain

Rads:

Answer 15

CXR, ± Echo, ± CT

Question 16

Chest Pain

Add’l studies:

Answer 16

Serial ECGs
Bilateral Blood Pressures

Question 17

Chest Pain

Life threats: Arrhythmia Treatment:

Answer 17

Meds vs Shock

Question 18

Chest Pain

Life threats: Hypotension Treatment:

Answer 18

• IVF
• Dopamine 2-10 mcg/kg/min or Norepinephrine 2-10 mcg/min IV
• ± IABP/ cath

Question 19

Chest Pain

Life threats: Pulm edema (CHF)Treatment:

Answer 19

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)

Question 20

Chest Pain

Life threats: STEMI Treatment:

Answer 20

• 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.

Question 21

Chest Pain

Life threats: Aortic Dissection Treatment:

Answer 21

• 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.

Question 22

Chest Pain

Life threats: PE Treatment:

Answer 22

• 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.

Question 23

Chest Pain

Life threats: Tamponade Treatment:

Answer 23

2 LB IV, ± Pericardiocentesis, CT surg

Question 24

Chest Pain

Life threats: Tension PTX Treatment:

Answer 24

Off vent, Needle D, chest tube

Question 25

Chest Pain

Life threats: Boerhaave’s Treatment:

Answer 25

IVF, Zosyn 3.375 gm IV, Gentamicin 7mg/kg IV, CT/gen surg consult