Chest pain Flashcards
Introduction
- *W**ash hands
- *I**ntroduce yourself
- *P**atient’s consent
- *E**xplain procedure/purpose for Hx
PC
“What brought you in today?”
HPC
Explores pain (SOCRATES):
Previous episodes
Site - “where is the pain?”
Onset and duration - “when did it start?”, “was this sudden or gradual?”, “how long did the pain last for?”
Character - “how would you describe the pain?”, “is the pain constant or intermittent?”
Radiation - “does the pain move anywhere apart from your chest?”
Associated symptoms - “did you get any:
- Heartburn*
- SOB*
- Shoulder pain*
- Sweating*
- Nausea and vomiting*
- Anxiety or palpitations?”*
Timings - “does the the pain come on at particular times of the day?”
Exercabating/relieving factors - “does anything make the pain better?”, “does anything make the pain worse?”
Severity - “how would you rate the pain on a scale of 1-10, with 1 being very little pain and 10 being excruciating pain?”
ICE (you may not need to do this for this station, as the pt is presenting with a medical emergency)
Ideas - “what do you think could have caused your chest pain?”
Concern - “is there anything that your worried about regarding your chest pain?”
Expectation - “what were you hoping we would do for you today?”
PMH
“Do you have any medical conditions like hypertension, high cholesterol, ischaemic heart disease, diabetes?”
DH
“Have you been prescribed any medications by your doctor? Are you taking any over the counter medications?”
Allergies & reactions - “do you have any allergies to any medications?”, “What happened when you took that medication?”
FH
“Does anyone in your family have any medical conditions like hypertension, high cholesterol, ischaemic heart disease, diabetes?”
SH
Alcohol, smoking, recreational drugs (including IVDU) - “do you smoke?”, “how much do you smoke each day?”, “how long have you smoked for?”, “have you ever smoked? How much did you smoke and for how long?”(if the patient said they don’t smoke),”do you drink?”, “how much/what do you drink each day?”, “do you use recreational drugs?”, “have you ever injected drugs or shared needles with other people?”
Occupation - “do you work?”, “what do you do for work?”
Home situation - “what’s your home situation like?”, “do you need help with things like cooking, washing/cleaning yourself?”
Examination
Ask to examine patient
“I’d like to examine you now and take your pulse, your blood pressure and your breathing/respiratory rate”
DDx
Explains to patient what ECG shows - “the ECG shows that your heart is beating very fast at a rate of 150 beats per minute”
Explains to patient the most likely diagnosis - “The most likely diagnosis is an acute coronary syndrome which is a heart attack”
Explains what else could be causing the pain - “your chest pain could also be cause by reflux, a clot in your lungs, or could be pain in your muscles”
Management
Makes management plan with patient - “So now, I’d like you to please take some 300mg of aspirin, and I’ll spray this GTN spray under your tongue”
Refers immediately as an emergency to the ambulance - “I’ll also be calling the ambulance immediately to take you to the hospital as this is a medical emergency”
Explains why patient can’t go in your car - “I’m really sorry, but unfortunately you won’t be able to go in my car as it’s not safe and I’m most likely not insured to take you to the hospital. Really sorry about this”
