Chest Pain

Question 1

what tests to order in chest pain?

Answer 1

troponin
U&Es
FBCs
CXR
ECG
ABGs if hypoxic
amylase, D-dimers

Question 2

three overview differentials for chest pain

Answer 2

1. acute coronary syndromes
2. acute aortic syndromes
3. PE

Question 3

what are the acute coronary syndromes?

Answer 3

STEMI
NSTEMI
unstable angina

Question 4

what are the acute aortic syndromes?

Answer 4

rupture
dissection
penetrating ulcer

Question 5

other causes of chest pain

Answer 5

GORD
peptic ulcer
pneumonia
pericarditis
pneumothorax
MSK
pleurisy
gall bladder/ pancreas
shingles
anxiety
drugs

Question 6

drugs that cause chest pain

Answer 6

5FU (carboplatin and fluorouracil)
cocaine
triptans

Question 7

what are 5FU used in?

Answer 7

cancer of the head and neck

Question 8

which troponins are specific to the heart?

Answer 8

I and T

Question 9

what 5 R’s are fluid used in?

Answer 9

resuscitation
replacement
routine maintenance
redistribution
reassessment

Question 10

initial fluid resuscitation

Answer 10

crystalloid rather than colloid

Question 11

examples of crystalloid solutions

Answer 11

Hartmann’s
lactated Ringer’s
plasma-lyte 148

Question 12

why is 0.9% NaCl not used in resuscitation?

Answer 12

can result in hypercholaemic metabolic acidosis

Question 13

when is 0.9% NaCl preferred in resuscitation?

Answer 13

rhabdomyolysis and AKI/CKD

due to the risk of hyperkalaemia