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Emergency Medicine > Chest Pain > Flashcards

Chest Pain Flashcards

1
Q

enters the CNS at multiple levels without precise mapping and is therefore difficult to locate

A

visceral pain fibers

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2
Q

what kind of fibers is described as an ache, discomfort, or heaviness?

A

visceral pain fibers

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3
Q

enters the CNS at specific levels and maps to specific areas of the parietal cortex and has dermal distribution

A

somatic pain fibers

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4
Q

what kind of fibers is described as a sharp pain that is precisely located?

A

somatic pain fibers

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5
Q

what is the safety net in EM for chest pain? (6)

A

vital signs + pulse oximetry
defib pads
O2 supplementation
IV access
EKG (at least 1)
+/- aspirin, nitroglycerin

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6
Q

what answer to the question “how long does the chest pain last when you have it?” is worrisome?

A

“several minutes to an hour”

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7
Q

what answer to the question “how long does the chest pain last when you have it?” is semi-reassuring?

A

“few seconds or constant for > 24 hours”

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8
Q

what 2 diagnostics are required?

A

serial EKGs
2-view Chest xray

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9
Q

patient disposition if not sick but patient has known heart disease?

A

admit

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10
Q

patient disposition if not sick but patient is elderly with comorbidities?

A

admit

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11
Q

patient disposition if not sick and patient is healthy, young, and does not have any comorbidities?

A

D/C with close follow up

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12
Q

acute coronary syndrome encompasses spectrum from ____ _____ to _____

A

stable angina
MI

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13
Q

characterized as cardiac chest pain at rest

A

unstable angina

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14
Q

characterized as cardiac chest pain with exertion?

A

stable angina

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15
Q

what is the treatment for a STEMI and NSTEMI? (4)

A

“MONA”

aspirin 324 mg
nitroglycerin
oxygen
morphine

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16
Q

what are 4 contraindications to nitroglycerin in a patient with a STEMI or NSTEMI?

A

phosphodiesterase inhibitors w/in 24 hrs
SBP < 90
bradycardia
right ventricular infarct

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17
Q

what is the difference between a STEMI and an NSTEMI?

A

NSTEMI cannot be confirmed without labs (troponin)

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18
Q

what is the treatment for an NSTEMI after it has been confirmed with a troponin level? (2)

A

admit
enoxaparin (levonox) OR heparin

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19
Q

what is the management for chest pain from suspected angina? (3)

A

treat chest pain
cardiac catheterization
stress test next morning

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20
Q

what can be used to assess risk?

A

HEART score

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21
Q

what does the HEART score stand for?

A

History
EKG
Age
Risk factors
Troponin

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22
Q

what is the disposition for HEART score 0-3? (2)

A

discharge w/ follow up
OR
stress

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23
Q

what is the disposition for HEART score 4-6?

A

admit

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24
Q

what is the disposition for HEART score 7 or greater?

A

interventional candidate

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25
Q

what criteria should we start with if PE is suspected?

A

Wells Criteria

26
Q

what is the next step for PE if the Wells score is 4 or less?

A

do PERC for possible D-Dimer

27
Q

what is the next step for PE if the Wells score is 4.1 or more?

A

CT lung angiogram

28
Q

any _____ answer in PERC requires further evaluation with D-Dimer

A

positive

29
Q

what is the imaging diagnostic of choice for a PE?

A

CT pulmonary angiography

30
Q

what imaging can be used for PE in pregnant patients or patients with contrast allergy?

A

V/Q scan

31
Q

what imaging can be done in patients with signs of a DVT?

A

venous ultrasound

32
Q

which PE patients can be treated empirically?

A

S/S of PE + documented DVT

33
Q

what is the treatment for a PE?

A

enoxaparin

34
Q

a patient presents with a sudden onset of ripping or tearing pain radiating through upper back. Physical exam shows a unilateral pulse deficit and neuro deficit. Dx?

A

aortic dissection

35
Q

what is the imaging of choice for an aortic dissection? what other imaging can help?

A

CT angiogram (imaging of choice)
Chest xray

36
Q

chest xray reveals widened mediastinum, abnormal aortic contour, and pleural effusion. What is the likely diagnosis?

A

aortic dissection

37
Q

management for aortic dissection? (2)

A

SURGERY
+/- antihypertensive meds (esmolol)

38
Q

a patient presents with a history of sudden onset, sharp substernal chest pain after forceful vomiting. the patient is tachycardic, febrile, dyspneic/diaphoretic. Dx?

A

boerhaave syndrome (esophageal rupture)

39
Q

what imaging helps diagnose boerhaave syndrome?

A

CT w/ oral water-soluble contrast

40
Q

management for boerhaave syndrome?

A

SURGERY

41
Q

what should we prepare for with boerhaave syndrome?

A

tension pneumothorax

42
Q

air accumulation in pleural space

A

pneumothorax

43
Q

a patient presents with a sudden onset, sharp, pleuritic chest pain with dyspnea. on physical exam, there is decreased breath sounds and hyperresonance to percussion on the ipsilateral side. Dx?

A

pneumothorax

44
Q

what is the treatment for pneumothorax that is 3cm or less?

A

O2

45
Q

what is the treatment for pneumothorax that is more than 3cm?

A

chest tube

46
Q

occurs when air continues to accumulate in pleural space causing a mediastinal shift

A

tension pneumothorax

47
Q

a patient presents with tachypnea, hypotension, decreased O2 sat, jugular venous distention and tracheal deviation. Dx?

A

tension pneumothorax

48
Q

what is the treatment for a tension pneumothorax?

A

EMERGENT needle thoracostomy chest decompression

49
Q

accumulation of fluid in pleural space

A

pleural effusion

50
Q

a patient presents with dyspnea, pleuritic chest pain, infectious S/S, has decreased breath sounds with hypo-resonance. Dx? Tx? (2)

A

pleural effusion

admit
drain/culture

51
Q

a patient presents with a fever, cough, back pain, pleuritic chest pain, and N/V. Dx?

A

pneumonia

52
Q

what is the imaging of choice for pneumonia?

A

chest xray

53
Q

treatment for pneumonia?

A

antibiotics

54
Q

a patient presents with a sharp, severe, constant pain with a substernal location. it radiates to back, neck, shoulders and is worse with inspiration and while laying flat. it feels better when sitting up and leaning forward. Dx? Management?

A

pericarditis

admit

55
Q

what is the classic finding of pericarditis?

A

pericardial friction rub

56
Q

what is the classic EKG finding in pericardiits?

A

diffuse ST-segment elevation w/ PR depression

57
Q

a patient presents with sharp, substernal chest pain, dyspnea, orthopnea, dysphagia, and hoarseness. physical exams shows distant cardiac sounds, JVD, and a pulsus paradoxus. Dx?

A

pericardial effusion

58
Q

what is the imaging of choice for a pericardial effusion?

A

bedside U/S

59
Q

what would a chest xray of a pericardial effusion look like?

A

enlarged radiopaque cardiac silhouette

60
Q

what is the treatment for a hemodynamically unstable cardiac tamponade?

A

pericardiocentesis

61
Q

what is the treatment for a hemodynamically stable cardiac tamponade?

A

admit

Emergency Medicine (12 decks)

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