Stable Patient
Give Aspirin (162-325 mg) unless there is a contraindication
Contraindications to Aspirin:
Hypersensitivity to Aspirin, i.e., syndrome of asthma, rhinitis, and nasal polyps; aspirin may cause severe urticaria, angioedema, or bronchospasm in these patients.
vital signs
Perform a focused physical exam (WHAT IS TO BE FOCUSED?)
Obtain an ECG within the first 10 minutes of arrival.
Establish IV access and place the patient on cardiac monitoring.
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## Risk Stratification
Classify patients into low, intermediate, or high-risk categories based on clinical presentation, ECG findings, and initial test results[4].
## Management Based on Risk and Diagnosis
### Acute Coronary Syndrome (ACS)
- For ST-elevation MI: Immediate reperfusion therapy (PCI preferred within 90 minutes, or thrombolytics if PCI unavailable)[1].
- For non-ST elevation ACS: Admit for cardiology consultation and further workup[1].
### Pulmonary Embolism
- Stable patients: Start anticoagulation
- Unstable patients: Consider thrombolysis[1]
### Other Conditions
- Pneumothorax: Chest tube decompression
- Pericardial tamponade: Pericardiocentesis
- Aortic dissection: Urgent surgical consultation[1]
## Ongoing Care
- Provide appropriate pain management
- Consider oxygen therapy if indicated
- For stable angina, outpatient workup may be appropriate[1]
## Shared Decision-Making
Involve patients in treatment decisions, providing information about risks, benefits, and alternatives[4].
## Discharge and Follow-up
For low-risk patients not requiring admission, ensure appropriate follow-up and provide clear instructions on when to seek further medical attention[3].
Remember, chest pain can be a sign of a life-threatening condition. When in doubt, it's crucial to err on the side of caution and seek immediate medical attention, especially if symptoms are severe, worsening, or lasting more than 10 minutes[3].
Citations:
[1] https://www.ncbi.nlm.nih.gov/books/NBK470557/
[2] https://www.healthline.com/health/chest-pain
[3] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/chest-pain
[4] https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029
[5] https://www.mayoclinic.org/first-aid/first-aid-chest-pain/basics/art-20056705
[6] https://www.aafp.org/pubs/afp/issues/2020/1215/p721.html
[7] https://www.nhlbi.nih.gov/health/angina/treatment