Chest Pain

Question 1

(1) _________ accounts for 5% of all visits to U.S. Emergency departments.
(2) Causes of __________ can range from emergent to benign and it is your
job to thoroughly investigate to discover what the true etiology is.

Answer 1

Chest pain General

Question 2

(a) Description of Pain
(b) Quality of the Pain (sharp, dull, achy, pressure, tearing).
(c) Region or Location of Pain
(d) Radiation
(e) Temporal Elements
(f) Provocation (what makes it worse)
(g) Palliation (what makes it better)
(h) Severity
(i) Associated symptoms (nausea, numbness, SOB, pre-syncope,
palpitation).
(j) OLDCARTS or OPQRST mnemonic.

PMHx, Family Hx, and Social Hx also very important.
Thorough physical examination.

Answer 2

Thorough history: Chest Px

Question 3

are the 6 life-threatening causes of acute onset chest pain
that MUST be considered in every patient with acute onset of chest pain.

Answer 3

“BIG 6”

Question 4

If you can rule out these 6 etiologies, you can very likely feel that the
patient will survive the next

Answer 4

24 hours.

Question 5

1) Acute Myocardial Infarction/Unstable Angina.
2) Pulmonary Embolism (PE)
3) Pericardial Tamponade
4) Esophageal Rupture
5) Tension Pneumothorax/Pneumothorax
6) Aortic Dissection/Rupture

Answer 5

“BIG 6” are

Question 6

1) Chest wall: Costochondritis, intercostal muscle strain, herpes
zoster, trauma, rib fracture.
2) Cardiac: Valvular heart disease, Mitral valve prolapse,
pericarditis, myocarditis, endocarditis, arrhythmia.
3) Pulmonary: Respiratory infections, pneumonia, pulmonary
malignancy, pleural effusions, pleurisy.
4) Psych: Anxiety, Depression, somatoform disorder.
5) GI: Esophageal reflux, esophageal spasm, pancreatitis, biliary
(choledocholithiasis, peptic ulcer).

Answer 6

Other Non-Emergent causes of chest pain

Question 7

(1) EKG to evaluate for AMI, arrhythmia, pericarditis.
(2) Cardiac enzymes
(3) Chest X-ray
(4) CT chest for Aortic dissection, PE
(5) FAST Exam/TTE to look for pericardial tamponade

Answer 7

Labs/Studies/EKG: Chest Px

Question 8

Treat the underlying cause of the chest pain. If the diagnosis is one of
the big 6, then remember ABCs, IV, O2 if saturation < 94%, Monitor
and appropriate treatment, then TRANSFER ASAP.

Answer 8

Treatment: Chest Px