CHEST PAIN SILVER CROSS EMS EMD CE FEBRUARY 2012
Common Causes of Chest Pain • Cardiovascular: • ischemia (AMI or angina) • pericarditis (irritation of pericardium) • thoracic aortic dissection • Respiratory: • PE (pulmonary embolism) • pneumothorax • pneumonia • pleural irritation • hyperventilation (anxiety)
Common Causes of Chest Pain • Gastrointestinal: • cholecystitis (gall bladder/gallstones) • pancreatitis • hiatal hernia (part of stomach pushes through diaphragm) • esophageal disease/GERD • peptic ulcers • dyspepsia (indigestion)
Common Causes of Chest Pain • Musculoskeletal: • chest wall syndrome (inflamed chest wall) • costochondritis (inflamed rib cartilage) • herpes zoster (shingles) • chest wall trauma • chest wall tumors
Chest Pain • There are literally dozens of illnesses, injuries and conditions that can cause chest pain. • Knowing common signs, symptoms and patient presentations can help you differentiate between different kinds of chest pain. • Bottom Line: If you are ever not sure what kind of chest pain you are dealing with, treat it as cardiac.
QUESTIONS TO HELP DIFFERENTIATE CHEST PAIN • CAUSE • ONSET OF PAIN • CHARACTERISTIC OF PAIN • LOCATION OF PAIN • HISTORY • ASSOCIATED Signs & Symptoms • AGGRAVATING FACTORS • RELIEVING FACTORS • All are further explained in following slides
ONSET/DURATION OF PAIN What were the doing when the pain started? • Constant? • Sudden? • How Long has it been going on? How severe is it? • 1-10 scale with 10 being the worst
Provokes or Relieves the Pain • Is there anything that makes it better or worse? • Movement or Exertion (might be muscular or cardiac) • Deep breaths or coughing (might be lung or muscular) • Rest (could be angina or muscular) • Position (could be muscular) • Pain relievers or Antacids (usually not cardiac) • Stress (may be anxiety or cardiac)
“QUALITY” Or TYPE Of PAIN • PLEURITIC (sharp pain with inhalation) • SPASMODIC (like a spasm) • TIGHTNESS OR HEAVINESS • PRESSURE- OPPRESSIVE • SHARP/LOCALIZED (easy to pinpoint) • VISCERAL (hard to pinpoint)/BURNING • TEARING / EXCRUCIATING
LOCATION and MOVEMENT • SUBSTERNAL • CENTER OR ACROSS CHEST • LATERAL CHEST • LOCALIZED OVER INVOLVED AREA • LOWER CHEST/EPIGASTRIC • RADIATES TO JAW, NECK, BACK OR ARM • VAGUE
HISTORY (Recent and Past) • AGE • PREVIOUS EPISODES • UPPER RESPIRATORY INFECTION/FEVER • TRAUMA • STRESS • EMOTIONAL UPSET • CARDIAC DISEASE – HIGH BLOOD PRESSURE, CORONARY ARTERY DISEASE, ANGINA
Associated Signs/Symptoms? • DYSPNEA (Difficulty Breathing) • DIAPHORESIS (Sweating), COOL OR CLAMMY SKIN • NAUSEA / VOMITING • ALTERED MENTAL STATUS (Including Anxiety and Restlessness) /WEAKNESS /LIGHTHEADEDNESS / SYNCOPE (Fainting) • DECREASED OR ABNORMAL BREATH SOUNDS • CYANOSIS (Bluish tint to skin from lack of oxygen) • HEMOPTYSIS (coughing up blood) • PULSATING ABD MASS • ABDOMINAL or BACK PAIN • PAIN WITH PALPATION • RASH OR LESIONS • ABNORMAL BLOOD PRESSURE
Acute Myocardial Infarction“Heart Attack” S & S Sudden onset of pain that does not go away with rest or analgesic Medication. Pain will be Substernal (center of chest, behind breast bone) and sometimes radiate to left jaw, back or shoulder.
True Cardiac Issues may also have complaints of…….. • Shortness of breath • Skin color will be poor with sweating • Victim may be nauseated, lightheaded or dizzy • Pain description usually varies from a pressure/heaviness to sharp or crushing • Pain may be relieved with Nitroglycerin if patient has been prescribed for Angina pain WHEN IN DOUBT, ASSUME HEART ATTACK!
Compare and Contrast The next slide shows a variety of conditions that may cause chest pain and some of the other associated signs and symptoms for your review.
Heart Conditions • The heart must receive a constant supply of oxygen or it will die. • The heart receives its oxygen through a complex system of coronary arteries. • These arteries may narrow as a result of atherosclerosis. • Progressive atherosclerosis can cause angina pectoris, heart attack, and cardiac arrest.
Heart Attack • Results when one or more of the coronary arteries is completely blocked • Two causes of coronary artery blockage: • Severe atherosclerosis • Blood clot
New Chest Pain Pre-Arrival Instructions • Your protocol will be changing to include the administration of aspirin to victims that may be having a heart attack. Why, you ask? Read on…… • Most heart attacks develop when a cholesterol-laden plaque in a coronary artery ruptures. Relatively small plaques, which produce only partial blockages, are the ones most likely to rupture. When they do, they attract platelets to their surface. Platelets are the tiny blood cells that trigger blood clotting. A clot, or thrombus, builds up on the ruptured plaque. As the clot grows, it blocks the artery. If the blockage is complete, it deprives a portion of the heart muscle of oxygen. As a result, muscle cells die — and it’s a heart attack. • Aspirin helps by inhibiting platelets. Only a tiny amount is needed to inhibit all the platelets in the bloodstream; in fact, small amounts are better than high doses. But since the clot grows minute by minute, time is of the essence. Chewed Aspirin can work in 5-15 minutes and can really make a difference in patient outcome.
New Chest Pain Protocol Key questions will include: • Descriptions of pain and associated S & S • Availability of aspirin on scene • Allergies to aspirin • Bleeding disorders or recent GI bleed Pre-arrival Instructions: • Calm, reassure patient • Let them assume comfortable position and loosen tight clothing • If they have medications for chest pain follow their doctors orders • If there are no contraindications, advise them to chew 1 adult or 4 low dose (baby) aspirins which they may follow with a few sips of water Most be aspirin or aspirin containing product. Other pain relievers do not have the same affect!
New protocols coming soon! • The final revisions are being made and will be going to Dr. Dave for approval soon. Watch for future announcements and flipchart review sessions to go over the changes.
