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Ch. 47

Common causes of chest pain

Causesigns and symptomsTypical Emergency Managment
angina pain, squeezing, or heaviness in the chest, jaw, left arm, or left shoulder that isn't relived by nitro; dyspnea, diaphoresis, nausea, in female pt: all of the above or back pain, syncope, gastric symptoms, heart palpitations administer nitro and O2, provide restful environment
gastroesophageal reflux disease belching with heartburn triggered by large meals, spicy food, alcohol, and eating before bedtime; worsening of symptoms about 1 hour after meals not an emergency, tests may rule out cardiac causes, treatment includes GI evaluation and medication to reduce stomach acid production
pericarditis chest pain that is worse with inspiration; fever, malaise, dyspnea, chills not an emergency; tests to rule out cardiac causes; treatment includes anti-inflammatory medication and possibly antibiotics
cholecystitis colicky epigastric pain that radiates to the right upper quadrant, right shoulder and back; nausea, vomiting, fever, jaundice and pruritus, tachycardia, light stools and dark urine not an emergency although pain maybe severe, tests may rule out cardiac causes, pt maybe hospitalized for cholecystectomy or lithotripsy
costochondritis chest pain over the sternum that may radiate into the shoulders and arms and is worse with a deep breath, tenderness on or around the sternum to palpation not an emergency, usually identified by a brief physical exam, tests may rule out cardiac cause, treatment includes nsaids, and ice
pulmonary embolism chest pain with inspiration, cough, low-grade fever, dyspnea, tachypnea, occasional hemoptysis, cyanosis, shock monitor ABC, administer O2 and ventilator support prn, measures to rule out cardiac cause may include EKG and cardiac enzyme studies
spontaneous pneumothorax sudden sharp pleuritic chest pain, mild to moderate dyspnea, decreased breath sounds on affected side, decreased O sat, tachycardia, tachypnea, anxiety O2 as ordered, position pt for comfort and optimal lung expansion, chest x-ray to confirm, prepare to assist w/ chest tube or Heimlich valve placement, pt may be transported to hospital for further care
panic attack sudden onset of chest palpations, tachycardia, tachypnea, diaphoresis, trembling, dyspnea, chest pain, nausea, paresthesias, dizziness, chills, or hot flashes; feelings of anxiety or impending doom not an emergency, tests may rule out cardiac or GI causes, treatment may include reassurance and anti-anxiety meds
myocardial infarction pain, squeezing, or heaviness in the chest, jaw, left arm, or left shoulder that isn't relived by nitro; dyspnea, diaphoresis, nausea, in female pt: all of the above or back pain, syncope, gastric symptoms, heart palpitations ABC; administer O2, morphine, nitro, aspirin, thrombolytic, antiarrythmic meds per order; provide pt w/ restful environment; provide bcls or acls as needed
Created by: rewebb
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