- Usually we send this pt to RED ZONE
a) Life threatening
- Thoracic aortic dissection
- Esophageal rupture
- Tension pneumothorax
- ACS(e.g. MI,UA)
- Pulmonary embolism
b) Most common
- GI: GERD,PUD
Things to ask:
O – Onset: “When did the pain starts?”
P – Provocation: “during cough, stress, after food and RECENT SPORT that might lead to overuse of chest muscle.
Q – Quality: “describe your pain; dull, sharp”
R – Radiation: to the head, scapula, left hand.
S – Severity:“I give u the scale from 1-10,10 is the most painful…which number is your severity?”
- PMH: HT, DM, cerebrovasc dss, PE.
- Medications? – drugs can trigger coronary artery spasm(e.g. cocaine, NSAID)
*If possible, ask the pt to hand the drugs to you.
- What position relieves the pain?
- Palpate and check skin of chest – trauma, abrasion, bruises, subcutaneous emphysema(crackles sound when palpate)
*Main Aim: TRO Life threatening causes!!
- Pulse oximetry
- ECG within 10min
- Look for cardiac markers: TRO ACS etiology(e.g. troponin,CK-MB)
*If STEMI à start PCI or thrombolytic therapy within 90 min standard.( refer STEMI)
Suspect PE if
- Leg swell
- HR > 100
- >3days immobilization
- History of surgery within the last 4 weeks
Thoracic Aortic Dissection
- Blood penetrates the tunica intima and the pressure tears the tunica media of the blood vessels.
- 2 type
1) Type A – in ascending aorta (typically chest pain)
2) Type B – in descending aorta (usually abdominal pain)
- History of HT,blunt trauma to chest.
- Dx: TEE(transesophageal echochardiography)and MRI-gold standard, CT scan.
- Within 2 weeks(80% mortality).
- Tx : surgery or HT tx
- a minimum of 100ml fluid in pericardium is enough to cause this.
- Beck’s triad:
1) Low arterial BP – bcos low stroke volume.
2) Jugular vein distension – in non-supine position due to diastolic filling of RV.
3) Muffled heart sound (decrease heart sound)– effects of passing thru fluid in pericardium.
- Etio: pericarditis,myocardial rupture, blunt trauma.
- Dx: ECG – low voltage QRS complex
- Signs n symptom of shock(tachycardia, apnea, decrease level of consciousness .
- Tx: pericardiocentesis at 5th intercostals space.
- chest pain is sharp and pleuritic,dyspnoe,cyanosis,tracheal deviation,jugular venous distension
- do CXR to confirm
- Tx: insert largest cannula into the 2nd intercostal space in the midclavicular line at the site with the absent or reduced breath sounds.
- If air rushes out,leave the cannula in place until a chest drain is inserted.
Auscultation of abdominal aorta : at the back of the patient lower a bit from interscapular region,slightly left from the vertebra.