4 hours ago · Although the term ‘chest pain’ is used in clinical practice, patients often report pressure, tightness, squeezing, heaviness, or burning in locations in addition to the chest, including the shoulder, arm, neck, upper abdomen, or jaw. Chest pain should be described as cardiac, possibly cardiac, or noncardiac rather than as typical or atypical. >> Go To The Portal
Although the term ‘chest pain’ is used in clinical practice, patients often report pressure, tightness, squeezing, heaviness, or burning in locations in addition to the chest, including the shoulder, arm, neck, upper abdomen, or jaw. Chest pain should be described as cardiac, possibly cardiac, or noncardiac rather than as typical or atypical.
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Although the term ‘chest pain’ is used in clinical practice, patients often report pressure, tightness, squeezing, heaviness, or burning in locations in addition to the chest, including the shoulder, arm, neck, upper abdomen, or jaw. Chest pain should be described as cardiac, possibly cardiac, or noncardiac rather than as typical or atypical.
However, asking pertinent questions regarding the type of pain the patient is experiencing, performing a thorough objective exam and obtaining the appropriate diagnostic tests will help lead to the correct diagnosis in the initial evaluation of a patient with chest pain.
According to the National Health Statistics Reports on Ambulatory Medical Care Utilization Estimates for 2006, 9 million patients had a complaint of chest pain and more than 2.5 million went to a primary care office for diagnosis and treatment.
This case shows that clinicians must always evaluate each complaint of chest pain as if it were new. Additionally, patients who complain of chest pain won't always have the expected signs and symptoms.
There are seven elements (at a minimum) that we have identified as essential components to documenting a well written and complete narrative.Dispatch & Response Summary. ... Scene Summary. ... HPI/Physical Exam. ... Interventions. ... Status Change. ... Safety Summary. ... Disposition.
Essential documentation for chest pain includes the date and time the pain started. Ask your patient about his pain, and record the responses using his own words, when appropriate. Also include the following: what he was doing when the pain started.
If you or someone else may be having a heart attack, follow these first-aid steps:Call 911 or emergency medical assistance. ... Chew aspirin. ... Take nitroglycerin, if prescribed. ... Begin CPR on the person having a heart attack.More items...
Questions aimed at identifying the patient with possible ACS:Where is your pain? (location)Does it go anywhere else? (radiation)When did it start? (onset)How long has it lasted? (duration)How bad is it? (severity on pain scale)Does anything make it better or worse?Have you taken any medication to relieve it?More items...
Documentation of a basic, normal respiratory exam should look something along the lines of the following: The chest wall is symmetric, without deformity, and is atraumatic in appearance. No tenderness is appreciated upon palpation of the chest wall. The patient does not exhibit signs of respiratory distress.
Chest Pain also called Angina is a medical condition which involves chest pain due to the decrease in the blood supply to the heart. It is one of the definitive symptoms of coronary heart disease, and can also be a symptom for other cardiac issues.
When documenting a patient's description of his or her chest pain or discomfort, the EMT should: Use the patient's own words. You and your EMT partner are the first to arrive at the scene of an unresponsive 70-year-old man.
Medications for the Treatment of Acute Coronary SyndromeTherapyRecommendations for STEMIAtorvastatin (Lipitor)40 to 80 mg per dayMorphine4 to 8 mg IV every five to 15 minutes as neededNitroglycerin0.4 mg sublingually every five minutes, up to three doses as blood pressure allows10 mcg per minute IV28 more rows•Feb 15, 2017
Recording 12 lead ECG has a central role in the early assess- ment of patients with suspected ischaemic chest pain. It is recommended that recording and interpreting a 12 lead ECG within 10 minutes of patient presentation is best practice.
This can feel like a squeezing, tightness, pressure, constriction, strangling, burning, heartburn, fullness in the chest, band-like sensation, knot in the center of the chest, ache, heavy weight on the chest, or a bra that is too tight. People with pain that is not angina often describe their pain as sharp or stabbing.
An EMS practitioner for nearly 15 years, Patrick Lickiss is currently located in Grand Rapids, MI. He is interested in education and research and hopes to further the expansion of evidence-based practice in EMS. He is also an avid homebrewer and runner.
You find that Brian’s pain increases with palpation, but you do not note any obvious trauma to his chest. Brian states that the pain also increases when taking a deep breath and he has clear lung sounds in all fields. Your partner completes the 12-lead ECG and states that the rhythm is normal. Brian’s vital signs are:
Brian has a history of hypertension and takes a beta blocker, but cannot recall the name. He also has a family history of heart disease and an allergy to penicillin. As your partner sets up the monitor for a 12-lead ECG, you perform a focused secondary exam.
Referred pain usually occurs because both the nerves (afferent fibers) of the viscera and the somatic region enter the spinal cord at the same level. 6 Thus, the patient who has both visceral and somatic pain could have a sharper and more localized sensation of the pain in the chest region.
The decreased blood flow through an occluded or partially occluded coronary artery resulting in the sensation of heaviness or crushing-type feeling in the chest is an example of visceral pain. Somatic pain, on the other hand, is described as sharp, piercing, and specific to a local area.
When your patient has chest pain, you'll need to use your assessment skills to determine whether the patient is having an acute MI or some other life-threatening illness. By knowing the signs and symptoms of the various causes for chest pain, you can quickly assess and determine whether the patient has a life-threatening condition and provide appropriate and possibly lifesaving care.
Nociceptive pain arises from specific pain receptors and is classified as somatic or visceral in nature. Visceral pain originates from specific internal organs, such as the heart, liver, bowels, or bladder. The pain receptors in the viscera react to stretch, inflammation, and ischemia.
Somatic pain is reproducible. The clinician can reproduce the pain with palpation or the patient can cause the pain through movement. 4,5 Costochondritis is an example of somatic pain. Cardiac pain may have both a visceral and a somatic component or neither (silent myocardial infarction [MI]).
Although some physical findings are common for the various causes of chest pain, a patient with chest pain may not have all of these signs, and some patients may not have any signs at all (see Chest pain physical assessment clues ).
3–5 Pain in the chest region is mostly induced by mechanical, chemical, or thermal means and is considered to be nociceptive (see Mechanism of acute pain ).
A history of HTN is the most important predisposing condition for an aortic dissection. Pts with an aortic dissection typically present with tearing posterior chest and back pain or anterior chest pain. On physical exam there is a pulse deficit resulting in weak or absent carotid, brachial or femoral pulses. There are usually no EKG changes that would indicate ischemia. Chest CT, MRI, or multiplane transesophageal echocardiography can be used for imaging after the patient is stabilized. Cardiac enzymes in an aortic dissection will be negative.
Symptoms felt with reflux can thus often mimic angina . A patient with reflux may also experience regurgitation of the gastric contents producing a sour taste in the mouth. This confluence of symptoms does not correlate with what ---- stated that he was experiencing. His chest pain was not substernal nor was it squeezing/burning in nature. He also denied any regurgitation or that the pain was associated with meals. Therefore, I do not believe that ----’s symptoms are due to reflux/GERD.
Worsening angina, angina at rest, or angina that lasts more than 15 minutes are all typical signs of unstable angina. A patient with unstable angina does not have ST elevation or new Q waves on EKG and serum CK-MB and troponin are normal. Based upon this information it seems that it is very likely that SR may have unstable angina. His chest pain has not been precipitated by exertion (as with stable angina), but has come on with varying degrees of activity from rest (sitting in bed) to mild exertion (walking around house). Also, once SR was given nitroglycerin in the ED, he stated that his pain had receded somewhat. The only factor in his history that makes the diagnosis of unstable angina less likely is the fact that his chest pain lasts only 2-3 minutes. Typically chest pain associated with unstable angina usually lasts more than
Risk factors for a MI are atherosclerosis, angina, previous MI or stroke, older age, smoking, hyperlipidemia, diabetes, HTN, obesity, etc. A patient that is having an acute myocardial infarction will typically present with substernal chest pain that may radiate to the shoulder, jaw, or arm as well as SOB, N/V, palpitations, and diaphoresis. On EKG there will be evidence of ST elevation or depression, Q waves, or inverted T waves. Cardiac enzymes such as troponin and CK-MB will typically increase within 3-12 hours after onset of chest pain if the pt is having a MI. A series of 3 measurements of cardiac enzymes is usually performed in order to monitor for elevations over time. All pts who are suspected of having a MI should receive an aspirin as well as nitroglycerin, as was done in the case of ----.
Pulmonary embolism is a common and often fatal disease, but the mortality from a PE can be reduced with rapid diagnosis and therapy. A pulmonary embolism typically occurs when a blood clot from a DVT travels to a pulmonary artery (or one of its branches) and obstructs it. Less commonly it can occur from fat or bone (after trauma), air, or amniotic fluid (after childbirth). Risk factors for pulmonary embolism include immobilization, recent surgery, stroke, malignancy, chronic heart disease, and h/o venous thromboembolism. Typically a pulmonary embolism presents with dyspnea, pleuritic chest pain, cough, hemoptysis, tachypnea, rales, tachycardia, hypotension, S4, and fever. Routine lab findings include leukocytosis, increased ESR, and elevated serum LDH or AST with normal bilirubin, however these findings are all nonspecific for PE. BNP, troponin, and D-Dimer can also be elevated in PE, but elevations in these can also be seen with other disorders as well. The gold standard for diagnosing PE is pulmonary angiography, but spiral CT is increasing in popularity. If hypoxemia exists, the patient should be started on supplemental oxygen. If the patient is hypotensive then IV fluids should be administered. Anticoagulation should also be started as soon as a PE is suspected.
(Location): Medic 1 responded to above location on a report of a 62 y.o. male c/o of chest pain. Upon arrival, pt presented sitting in a chair attended by first responder. Pt appeared pale and having difficulty breathing.
Patient does not respond to questions, but crew is informed by family that patient is deaf. Per family, the patient has been "sick" today and after consulting with the patient's doctor, they wish the patient to be transported to HospitalA for treatment.
PT has a sensitivity to Morphine Sulfate and is allergic to shellfish. PT has been complaint with his medication, according to his wife. PTs last meal was a chicken breast and rice. Upon our arrival PT was found sitting on the couch, in a high state of anxiety due to his flooded basement.