REBEL Core Cast – Basics of EM – Chest Pain

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

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Christine Ju, MD
Co-director of Student Clerkship, Emergency Medicine Residency Core Faculty
Modesto, CA
Twitter: @christinemju

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:

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