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CHEST PAIN, Spectrum of Acute Coronary Syndrome (ACS), Perform detailed…
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Diagnosis
✦Asymmetric breath sound
✦JVD
✦Tracheal deviation
Management
✦Needle decompression
✦Tube thoracostomy
Diagnosis
✦Muffled heart sounds
✦JVD
✦Hypotension
✦Pulsus paradoxus
Further Evaluation
✦Echocardiography
Management
✦Pericardiocentesis
Diagnosis
✦Diffuse ST-Segment elevations with PR-Segment deppressions
✦Pleuritic/positional pain
Management
✦Directed underlying etiology: infectious, post-MI, autoimmune
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Diagnosis
✦RV Strain: ST-Segment depressions or T-wave inversions in V1-V3
Further Evaluation
✦D-dimer or CT pulmonary angiography
Management
✦Anti-coagulation
✦Thrombolysis if unstable
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Diagnosis
✦Severe or tearing pain
✦Associated neurological symptoms/deficits
✦Pulse or BP differential
Management
✦BP and HR control
✦Emergent surgical consultation
Diagnosis
✦Hx recurrent vomiting
✦SubQ emphysema
Management
✦Broad-spectrum antibiotics
✦Emergent surgical consultation
Diagnosis
✦Fever, hypoxia, productive cough
Management
✦Antibiotics in indicated
Diagnosis
✦Pleuritic chest pain
✦Asymmetric breath sound
Management
✦Supplemental O2
✦Tube thoracostomy or small-bone percutaneous throacostomy guided by size
Skin, soft-tissue
✦Zoster
✦Cellulitis
Bone/Muscle
✦Costochrondritis
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Anterior Mediastinum
✦Thymoma
✦Lymphoma
Middle Mediastinum
✦Tracheitis
✦Bronchitis
Posterior Mediastinum
✦Esophagus
-Esophagitis, GERD
-Esophageal spasm
Gastrointestinal
✦Peptic ulcer disease
✦Gastritis
Hepatobiliary
✦Cholecystitis
✦Pancreatitis
Thoracic Spine
✦Epidural abscess
✦Osteomyelitis, discitis
✦Fracture
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- McConaghy, J. R., & Oza, R. (2013). Outpatient diagnosis of acute chest pain in adults. American family physician, 87(3), 177-182.
- Collet, J. P., Thiele, H., Barbato, E., Barthélémy, O., Bauersachs, J., Bhatt, D. L., ... & Karia, N. (2021). 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European heart journal, 42(14), 1289-1367. https://doi.org/10.1093/eurheartj/ehaa575
- Writing Committee Members, Gulati, M., Levy, P. D., Mukherjee, D., Amsterdam, E., Bhatt, D. L., ... & Shaw, L. J. (2021). 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology, 78(22), e187-e285. https://doi.org/10.1161/CIR.0000000000001029
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