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Emergency Medicine > Chest Pain > Flashcards

Chest Pain Flashcards

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1
Q

Described as ache, discomfort, heaviness, difficult to locate

A

Visceral pain fibers

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2
Q

sharp-type pain that is precisely located, dermal distribution

A

somatic pain fibers

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3
Q

What are the 6 deadly causes of chest pain?

A 
Acute Coronary Syndrome (AMI)
Pulmonary Emboli
Boerhaave Syndrome (Esophageal rupture)
Aortic Dissection
Tension pneumothorax
Cardiac tamponade/effusion
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4
Q

What is the safety net in chest pain?

A 
vital signs w/ pulse oximetry and defib pads
O2 supplementation
IV access
EKG
\+/- Aspirin, nitroglycerin
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5
Q

What is performed while the safety net is being established?

A

brief hx

quick assessment of airway, breathing, circulation

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6
Q

What is done in the secondary approach?

A

more through PMHx

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7
Q

What is a risk factor for chest pain?

A

1st degree relative with an MI before age 55
Age over 40
OCP meds, drug abuse, RThx

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8
Q

What do chest pain pts need?

A

Serial EKGs

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9
Q

What labs should be performed on a chest pain pt?

A 
CBC, Coagulation (INR etc.), CMP, Cardio enzyme (Troponin, CK, CK-MB)
Lipase
Qualitative pregnancy
U/A
Urine Tox
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10
Q

What Imaging should be done during the 2nd approach?

A

Chest Xray - 2v

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11
Q

What is the “Golden Egg”

A

patient disposition, admit and then talk yourself down as you gather more info

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12
Q

Known heart dz?

A

admit

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13
Q

Unsure

A

admit

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14
Q

Young, healthy, no comorbidities?

A

D/C w/ close follow up

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15
Q

sick

A

admit

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16
Q

What is unstable angina?

A

cardio chest pain at rest

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17
Q

What is stable angina?

A

cardio chest pain w/ exertion

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18
Q

What are the steps in a STEMI?

A 
Cath lab or Thrombolytic Checklist
Give aspirin 324mg chewable
Oxygen
Chest X-ray
\+/- Nitroglycerin
\+/- Morphine
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19
Q

What are C/I to nitroglycerin?

A

phospodiesterase inhibitors <24hrs
SBP <90mmHg
Bradycardia
Right ventricular infarct

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20
Q

What is the signs of a Right ventricular infarct?

A

ST elevation in II, III, aVF w/ reciprocal ST depression in lateral leads

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21
Q

What are the steps in NSTEMI?

A 
Aspirin 324mg chewable
Oxygen
Chest Xray
\+/- Nitroglycerin
\+/- Morphine
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22
Q

Once a NSTEMI is confirmed what steps are taken?

A

anti-coagulate w/ enoxaparin (Lovenox) or heparin

Admit

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23
Q

What are the steps for chest pain from a suspected angina?

A 
pt should be seen by a cardiologist and evaluated <3d of discharge
Stress test (exercise or chemical)
Cardiac CT
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24
Q

What screening tool is used to determine risk of mortality in 14 days due to MI?

A

TIMI Risk Stratification

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25
What screening tool is used to determine risk of a adverse cardiac event?
Heart Risk Stratification
26
Heart risk score of 0-3 can be?
discharged
27
Heart risk score of 4-6 can be?
admitted
28
Heart risk score of >7 can be?
interventional candidate
29
What is the goal of treatment for PE?
identify the problem and prevent the next pulmonary embolism
30
What two screening tools are used for PE?
PERC and Well's Criteria
31
What screening tool is used to r/o PE?
PERC
32
Any positive answer requires?
further eval
33
<4 points on Wells criteria calls for?
D-dimer
34
>4 points on Wells criteria calls for?
CT lung angiogram
35
TXT for a confirmed PE?
Enoxaprin 1mg/kg BID
36
Sudden onset of ripping or tearing pain radiating through upper back?
aortic dissection
37
What s/s are found a physical exam for Aortic dissection?
unilateral pulse deficit, neurological deficit
38
What is found on a Xray for aortic dissection?
widened mediastinum abnormal aortic contour pleural effusion
39
What is the imaging of choice for aortic dissection?
CT angiogram
40
What meds could be given in aortic dissection?
+/- antihypertensive
41
Sudden onset, sharp, substernal chx pain w/ forceful vomiting
Boerhaave Syndrome
42
What imaging is used for Boerhaave Syndrome?
CT w/ oral water soluble contrast
43
What should you be prepared to treat in Boerhaave?
pneumothroax
44
Sudden onset, sharp, pleuritic chx pain w/ dyspnea
pneumothorax
45
A pneumothorax is most common in?
tall, slender males
46
A pneumothorax under <3cm should be treated with just what?
O2
47
A pneumothorax larger than >3cm should be treated with what?
chest tube
48
A small percentage of pneumothorax develops into what?
tension pneumothorax
49
What is a tension pneumothorax?
air continues to accumulate in pleural space causing mediastinal shift
50
What is the txt for tension pneumothorax?
EMERGENT needle thoracostomy chest decompression
51
What is seen on chx xray for a tension pneumothorax?
NOTHING, its diagnosed clinically
52
What is a pneumothorax?
AIR accumulation in pleural space
53
What is a pleural effusion?
accumulation of FLUID in the pleural space
54
Dyspnea, pleuritic chest pain, infectious s/s
pleural effusion
55
What is txt for pleural effusion?
admit, drained and cultured
56
fever, cough back pain, pleuritic chest pain, n/v
pneumonia
57
What is the IOC for pneumonia?
Chest x ray
58
What is the txt for pneumonia?
abx
59
sharp, severe, constant pain w/ substernal location, may radiate to the back, neck or shoulders, worse with inspiration and while lying flat, relieved by sitting up or leaning forward
pericarditis
60
What is pericarditis?
infection or inflammation of the pericardium
61
What is the classic finding in pericarditis?
pericardial friction rub
62
What is the classic ECG findings in pericarditis?
diffuse ST-segment elevation w/ PR depression
63
Does pericarditis get admitted?
YES
64
What is pericardial effusion?
fluid accumulation in pericardial sac
65
sharp, substernal chest pain, dyspnea, orthopnea, dysphagia, hoarseness
pericardial effusion
66
The IOC for pericardial effusion?
beside US
67
What is seen on chest xray of pericardial effusion?
enlarged radiopaque cardiac silhouette
68
Hemodynamic instability txt?
pericardiocentesis
69
Hemodynamic stability txt?
admit
70
The symptom most likely indicative of a MI?
n/v w/ chest pain

Emergency Medicine (6 decks)

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