Take Home Points
- Take chest pain seriously – ACS and PE patients don’t always appear ill – look for the silent killer cases
- Remember 4-2-1 approach to chest pain = 4 chambers, 2 lungs, 1 esophagus
- EKG’s – get an old one to compare to for every patient and make sure to perform serial EKG’s
- Concerning sxs: diaphoresis, vomiting, radiation, exertional pain
- Don’t rely on a negative initial troponin to re-assure you – rely on you’re physical exam – if they look sick and sweaty – still consider ACS and get repeat EKG’s
- Improvement with NSAID or GI cocktail should not be re-assuring – this may still be ACS
- Don’t forget about atypical presentations – epigastric pain, DKA, shortness of breath, these by be cases of ACS
- Patients often confuse palpitations with pain – consider ischemic arrhythmias
- Don’t forget the skin exam! You may find zoster hiding
- Give aspirin to every patient unless they have an allergy
- Don’t discharge patients that are still having chest pain!
REBEL Core Cast – Basics of EM – Chest Pain
Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami)
Cite this article as: Ellsworth Wright, "REBEL Core Cast – Basics of EM – Chest Pain", REBEL EM blog, June 1, 2022. Available at: https://rebelem.com/rebel-core-cast-basics-of-em-chest-pain/.