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Chest Pain, Emergency Medicine

Josh W. Joseph and Edward Ullman Reviewed 06/2017
 


Basics

Description

  • One of the most frequent chief complaints in the ED

  • Often the presenting symptom of a high-risk etiology:

    • Acute coronary syndrome

    • Pulmonary embolism

    • Aortic dissection

  • Assume life threaten...

Diagnosis

Signs and Symptoms

  • Coronary artery disease:

    • Pressure

    • Squeezing pain

    • Radiation to arm, jaw

    • Shortness of breath

    • Diaphoresis

    • Nausea

    • Vomiting

    • Weakness

    • Fatigue especially in women or elderly

    • Signs of CHF

    • Anx...

Treatment

Pre-Hospital

  • Therapeutic interventions should be guided by the patient's presentation, risk factors, and past history.

  • If a cardiac life threat is suspected:

    • IV access

    • Cardiac monitoring

    • EKG

    • Oxyge...

Follow-Up

Disposition

Admission Criteria

Dependent on the risk for life-threatening cardiopulmonary etiologies 

Discharge Criteria

Safe if patient is deemed to have low-risk etiology of chest pain 

Issues for Referral

Pearls and Pitfalls

  • Caution in only ordering a single biomarker

  • Using response to medications as a diagnostic tool

  • Not using serial EKG in patients with suspected ACS or repeating EKGs when patients hav...

Additional Reading

  • Anderson  JL, Adams  CD, Antman  EM, et al. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Ele...

Codes

ICD9

  • 786.50 Chest pain, unspecified

  • 786.51 Precordial pain

  • 786.59 Other chest pain

  • 786.52 Painful respiration

  • 786.5 Chest pain

ICD10

  • R07.2 Precordial pain

  • R07.9 Chest pain, unspecified

  • R07.89 Other chest...

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