You are called to the ward because of a patient with sudden onset chest pain.
- Outline your initial steps.
An initial approach for this patient involves obtaining the following:
- History – onset, location, provoking/relieving factors, quality, radiation, severity, past history of similar pain, associated symptoms (diaphoresis, nausea, breathlessness, vomiting, hemoptysis, relationship of pain to food (r/o GERD or other esophageal etiologies), melena/hematochezia.Be sure to ask closed-ended, targeted questions, as a patient with acute chest pain will not tolerate a lot of talking.
- Past Medical History – similar symptoms, ACS, GERD
- Acquire data from patient chart – reason for admission, medications, past medical history
- Physical exam – vitals (HR, BP, RR, O2 sat, Temp), cardiac exam, respiratory exam
- What investigations would you order?
Investigations to order at this time:
- CBC, lytes
- ECG, Troponin, CK
- Chest xray
- CT Pulmonary Embolism if suspect PE
- Assuming your tests suggest an acute coronary syndrome (but no STEMI), what is your initial management at this time?
Put the patient on a monitor or telemetry
O2 supplementation (if O2 sat<94% or respiratory distress)In the event of ACS:
- Aspirin 81mg 2tab PO chew
- Metoprolol 25mg PO (if BP is elevated)
- Nitroglycerine 0.4mg spray SL (if BP will support)