EM Basic Chest Pain Flashcards
What is the mnemonic for 6 deadly causes of chest pain?
PET MAC PE Esophageal rupture Tension Pnemo MI Aortic Dissection Cardiac Tamponade
What is the workup for for pts w/chest pain?
EKG - screens for CAD, arrhythmia
CXR - pneumo, dissection, esophageal rupture
What gives an immediate ticket to CATH lab?
Chest pain + STE 2mm or > in 2 contiguous leads
Young thin smoker w/sudden onset of chest pain look for what?
Spontaneous pneumothorax
Esophageal rupture - how to rule out?
CXR - free air under diaphragm
Peritonitis on ABD exam
Hx of forceful vomiting - alcoholic?
Recent endoscopy
Dissection - how to r/o?
HTN hx, pregnancy, CT diseases Unequal BPs (> 20)
Chest pain + motor/Neuro think of what?
Dissection
What is an atypical presentation for females w/MI?
Fatigue, weak, Nausea, Diabetic
What labs to order for MI?
EKG CXR CBC - anemia? Chem10 - electrolyte abnormalities Coags - want baseline set Cardiac enzymes - troponin elevates in first 4-6 hours, CK 6-8
R/o MI give what for treatment?
325mg ASA
Nitroglycerin 0.4 mg sublingual q5 min x 3 doses, HOLD if systolic < 100 or no chest pain, if they pass out give them 500mL NS bolus
If still in Pain: 4 mg IV Morphine + 8mg Zofran
Repeat EKG before admit
What is the basic w/u for PE?
EKG CXR - maybe PA lateral CBC Chem10 - Cr for CT Coags - baseline needed
What is the PERC rule?
BREATHS mnemonic
Low risk for PE, no CTA needed BREATHS Blood in sputum RA sat < 95% Estrogen/OCP Age > 50 Thrombosis in PMHx HR > 100 Surgery in last 4 weeks
When should you get a d-dimer?
PERC +, usually bc of HR or OCPs
How to treat PE w/no vital signs change?
If no hemodynamically unstable?
1 mg/kg Lovenox subQ or Heparin and order Cardiac enzymes, BNP
Thrombolytics
PE w/u need what?
EKG CXR CBC Chem10 Coags Risk Stratify - Med/High —> Get CTA chest
