Clinical Scenarios: Chest Pain

  • Questions:
  •     - Location, Duration, Character, Severity
  •     - Radiating? (arm, neck, back)
  •     - Associated symptoms (diaphoresis, N/V)
  •     - Past History CAD
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  • Workup:
  •     - Troponin I, CK, CK-MB q8hrs
  •     - EKG
  •     - CXR
  •     - BMP
  •     - CBC
  •  
  • Goals of Management:
  • Is this ACS?
  • Determine whether hemodynamically stable
  • Reduce cardiac work (MONA-B):
  •     - Morphine 2-4mg IV
  •     - Oxygen
  •     - Nitro .4mg sublingual
  •     - ASA 325mg
  •     - Metoprolol 5mg IV q5min x 3
  • Determine if intervention needed:
  •     - CALL SENIOR
  •     - EKG: ST changes
  •     - Enzyme change