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Emergency Medicine > Chest Pain > Flashcards

Chest Pain Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Described as ache, discomfort, heaviness, difficult to locate

A

Visceral pain fibers

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2
Q

sharp-type pain that is precisely located, dermal distribution

A

somatic pain fibers

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3
Q

What are the 6 deadly causes of chest pain?

A 
Acute Coronary Syndrome (AMI)
Pulmonary Emboli
Boerhaave Syndrome (Esophageal rupture)
Aortic Dissection
Tension pneumothorax
Cardiac tamponade/effusion
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4
Q

What is the safety net in chest pain?

A 
vital signs w/ pulse oximetry and defib pads
O2 supplementation
IV access
EKG
\+/- Aspirin, nitroglycerin
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5
Q

What is performed while the safety net is being established?

A

brief hx

quick assessment of airway, breathing, circulation

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6
Q

What is done in the secondary approach?

A

more through PMHx

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7
Q

What is a risk factor for chest pain?

A

1st degree relative with an MI before age 55
Age over 40
OCP meds, drug abuse, RThx

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8
Q

What do chest pain pts need?

A

Serial EKGs

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9
Q

What labs should be performed on a chest pain pt?

A 
CBC, Coagulation (INR etc.), CMP, Cardio enzyme (Troponin, CK, CK-MB)
Lipase
Qualitative pregnancy
U/A
Urine Tox
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10
Q

What Imaging should be done during the 2nd approach?

A

Chest Xray - 2v

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11
Q

What is the “Golden Egg”

A

patient disposition, admit and then talk yourself down as you gather more info

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12
Q

Known heart dz?

A

admit

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13
Q

Unsure

A

admit

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14
Q

Young, healthy, no comorbidities?

A

D/C w/ close follow up

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15
Q

sick

A

admit

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16
Q

What is unstable angina?

A

cardio chest pain at rest

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17
Q

What is stable angina?

A

cardio chest pain w/ exertion

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18
Q

What are the steps in a STEMI?

A 
Cath lab or Thrombolytic Checklist
Give aspirin 324mg chewable
Oxygen
Chest X-ray
\+/- Nitroglycerin
\+/- Morphine
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19
Q

What are C/I to nitroglycerin?

A

phospodiesterase inhibitors <24hrs
SBP <90mmHg
Bradycardia
Right ventricular infarct

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20
Q

What is the signs of a Right ventricular infarct?

A

ST elevation in II, III, aVF w/ reciprocal ST depression in lateral leads

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21
Q

What are the steps in NSTEMI?

A 
Aspirin 324mg chewable
Oxygen
Chest Xray
\+/- Nitroglycerin
\+/- Morphine
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22
Q

Once a NSTEMI is confirmed what steps are taken?

A

anti-coagulate w/ enoxaparin (Lovenox) or heparin

Admit

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23
Q

What are the steps for chest pain from a suspected angina?

A 
pt should be seen by a cardiologist and evaluated <3d of discharge
Stress test (exercise or chemical)
Cardiac CT
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24
Q

What screening tool is used to determine risk of mortality in 14 days due to MI?

A

TIMI Risk Stratification

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25
Q

What screening tool is used to determine risk of a adverse cardiac event?

A

Heart Risk Stratification

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26
Q

Heart risk score of 0-3 can be?

A

discharged

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27
Q

Heart risk score of 4-6 can be?

A

admitted

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28
Q

Heart risk score of >7 can be?

A

interventional candidate

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29
Q

What is the goal of treatment for PE?

A

identify the problem and prevent the next pulmonary embolism

30
Q

What two screening tools are used for PE?

A

PERC and Well’s Criteria

31
Q

What screening tool is used to r/o PE?

A

PERC

32
Q

Any positive answer requires?

A

further eval

33
Q

<4 points on Wells criteria calls for?

A

D-dimer

34
Q

> 4 points on Wells criteria calls for?

A

CT lung angiogram

35
Q

TXT for a confirmed PE?

A

Enoxaprin 1mg/kg BID

36
Q

Sudden onset of ripping or tearing pain radiating through upper back?

A

aortic dissection

37
Q

What s/s are found a physical exam for Aortic dissection?

A

unilateral pulse deficit, neurological deficit

38
Q

What is found on a Xray for aortic dissection?

A

widened mediastinum
abnormal aortic contour
pleural effusion

39
Q

What is the imaging of choice for aortic dissection?

A

CT angiogram

40
Q

What meds could be given in aortic dissection?

A

+/- antihypertensive

41
Q

Sudden onset, sharp, substernal chx pain w/ forceful vomiting

A

Boerhaave Syndrome

42
Q

What imaging is used for Boerhaave Syndrome?

A

CT w/ oral water soluble contrast

43
Q

What should you be prepared to treat in Boerhaave?

A

pneumothroax

44
Q

Sudden onset, sharp, pleuritic chx pain w/ dyspnea

A

pneumothorax

45
Q

A pneumothorax is most common in?

A

tall, slender males

46
Q

A pneumothorax under <3cm should be treated with just what?

A

O2

47
Q

A pneumothorax larger than >3cm should be treated with what?

A

chest tube

48
Q

A small percentage of pneumothorax develops into what?

A

tension pneumothorax

49
Q

What is a tension pneumothorax?

A

air continues to accumulate in pleural space causing mediastinal shift

50
Q

What is the txt for tension pneumothorax?

A

EMERGENT needle thoracostomy chest decompression

51
Q

What is seen on chx xray for a tension pneumothorax?

A

NOTHING, its diagnosed clinically

52
Q

What is a pneumothorax?

A

AIR accumulation in pleural space

53
Q

What is a pleural effusion?

A

accumulation of FLUID in the pleural space

54
Q

Dyspnea, pleuritic chest pain, infectious s/s

A

pleural effusion

55
Q

What is txt for pleural effusion?

A

admit, drained and cultured

56
Q

fever, cough back pain, pleuritic chest pain, n/v

A

pneumonia

57
Q

What is the IOC for pneumonia?

A

Chest x ray

58
Q

What is the txt for pneumonia?

A

abx

59
Q

sharp, severe, constant pain w/ substernal location, may radiate to the back, neck or shoulders, worse with inspiration and while lying flat, relieved by sitting up or leaning forward

A

pericarditis

60
Q

What is pericarditis?

A

infection or inflammation of the pericardium

61
Q

What is the classic finding in pericarditis?

A

pericardial friction rub

62
Q

What is the classic ECG findings in pericarditis?

A

diffuse ST-segment elevation w/ PR depression

63
Q

Does pericarditis get admitted?

A

YES

64
Q

What is pericardial effusion?

A

fluid accumulation in pericardial sac

65
Q

sharp, substernal chest pain, dyspnea, orthopnea, dysphagia, hoarseness

A

pericardial effusion

66
Q

The IOC for pericardial effusion?

A

beside US

67
Q

What is seen on chest xray of pericardial effusion?

A

enlarged radiopaque cardiac silhouette

68
Q

Hemodynamic instability txt?

A

pericardiocentesis

69
Q

Hemodynamic stability txt?

A

admit

70
Q

The symptom most likely indicative of a MI?

A

n/v w/ chest pain

Emergency Medicine (6 decks)

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