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4 Cards in this Set
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Questions about Chest Pain
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LAQ CODIERS.
Location (Where is the chest pain?) Associated symptoms (nausea? diaphoresis? dyspnea? radiation? fever? cough?) Quality (pressure? dull? sharp? burning?) Chronology (Since onset, is it getting better or worse? Has it changed in position or character?) Onset (What were you doing when it started? Any idea why it started when it did?) Duration (Does it come and go? How long does it last when present?) Intensity (Compared to worst pain you’ve ever had, how bad is this pain on a scale from 1-10?) Exacerbating (Anything make it worse? What happens if you . . .?) Relieving (Anything make it better? Have you tried anything? What do you do when you get this symptom? Situation (Where or when does it usually occur? What were you doing the first time you noticed it?) "It does sound like things have been pretty stressful. I'd like to hear more about your symptoms. Did you feel this discomfort any place besides your chest?" "Have you ever had this discomfort before? "If you change position does it make a difference?" "Do you feel like you may have pulled a muscle carrying the carpet?" "Did it hurt to breathe?" |
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Make sure to check these things on PE for pt c/o CP
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The physical exam can be helpful in making a diagnosis of acute MI. First, check the vital signs--tachycardia or hypertension can be found with acute MI because of increased circulating levels of catecholamines. There are cardiac exam findings that may be suggestive for MI. A new murmur may be caused by papillary muscle rupture or dysfunction. An S3 or S4 may be heard as a result of damage associated with heart failure or decreased diastolic relaxation.
The exam can also be useful to support or refute alternate explanations for the patient’s symptoms. For instance: Pericardial rub on initial presentation suggests pericarditis. Lung crackles alone suggest heart failure, while the combination of fever, crackles, and decreased breath sounds is suspicious for pneumonia. Unilateral leg swelling hints at DVT/PE. RUQ tenderness can be seen with acute cholecystitis. Patients with GERD may have epigastric discomfort on palpation. Chest wall tenderness is noted in patients with trauma, costochondritis, and other muscular causes of chest pain. Be careful, however--patients with ACS may also report chest wall tenderness! Carotid, abdominal, or femoral bruits suggest atherosclerosis/peripheral arterial disease (PAD) – realize that a patient with PAD is more likely to have CAD as well, since atherosclerosis is a diffuse process. Pulse and BP differential from side to side may suggest significant peripheral arterial obstruction – including aortic dissection. Remember, this is a “can’t-miss” diagnosis in a patient presenting with acute chest pain. Although the history may not be classic for aortic dissection, it is important not to prematurely rule out these important differentials. |
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what is a GI cocktail made of?
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mixture of liquid antacid, viscous lidocaine, and an anticholinergic
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What are the contraindications to thrombolytic therapy?
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Major contraindications are bleeding and hemorrhagic stroke.
Thrombolytic agents, such as Tissue Plasminogen Activator (tPA), activate plasminogen with lysis of fibrin (and fibrinogen), resulting in rapid lysis of clot with reperfusion of the infarct-related territory and improving survival. Thrombolytics are indicated in patients with acute STEMI or new LBBB MI when primary PCI is not performed. The major complications associated with these agents are bleeding and hemorrhagic stroke. The absolute contraindications for thrombolytic therapy include: Strong suspicion of dissection of the aorta Pericardial effusion Active gastrointestinal or other internal bleeding Brain tumor, arteriovenous malformation, or aneurysm Ischemic stroke in preceding 6 months (a verified transient ischemic attack (TIA) is an exception) Previous intracerebral hemorrhage or subarachnoid hemorrhage Intracranial procedure or recent head trauma Severe known bleeding disorder: coagulation abnormality, thrombocytopenia, etc. |
