Common inpatient issue

CHEST PAIN
• Causes?
 Chest pain
• Heart/vascular
• GI
• Chest wall
• Psychiatric
• Pulmonary
• Substance abuse
 Chest pain
• Always check vital signs
• HR 60 – 100
• BP 120 / 80
• O2 saturation 98 -100
• RR 14-18
Chest pain?
 Chest pain!

• Myocardial infarction
• Pulmonary embolism
• Pneumothorax
• Cardiac Tamponade
• Aortic dissection
 Chest Pain
• Vitals
• 12 Lead EKG
– Compare to an old ekg
– Cardiac hx
 Chest pain
• Vitals
• EKG
• Order Cardiac enzymes
– Creatine kinase MB, peak 10-24 / 2-3 days
– troponin peak 12 / 7 days
– x 3 q8h
 Chest pain
• Vitals
• EKG
• Order Cardiac enzymes
• CXR
– PTX, Aortic dissection, Pleural effusion
 Chest pain
• Vitals
• EKG
• Order Cardiac enzymes
• CXR
 Cardiac - MI
• Consult cardiology
• O2
• Nitroglycerin
• ASA
• Cardiac monitor
 The others
• Costochondritis/muscle strain – long OR case;
point tenderness;
• Substance abuse – cocaine -
• PE/PTX- spiral ct/ddimer/ ABG/
– anticoagulate
• PUD/GERD- pt gives hx;
– Central pain; before/during meals
 JA
• Shoulder /neck pain left side; ache; 7/10;
• Vitals 130/88 ; 95; 99% 16
• 24 yo f s/p orthognathic sx mx/md/chin
– POD x 1
– Healthy
DDx
 Destro

• Difficulty breathing; pain in chest; right side;

8/10;
• Vitals : 154/94; 110; 92% ; 20
• 56 yo m s/p orif lefort 3 fx h/o htn, afib, MI x
2 yo ago s/p stent, obese BMI 40
• Meds: NTG, Coumadin, HCTZ, Nifedipine,
Lipitor,
DDx
 The oracle
• Vague pain in left chest, diaphoretic; nausea
• Vitals 160/96; 102; 17; 98%; 21
• 69 yo f w right submandibular infection h/o
uncontrolled dm; BMI 30; htn; high
cholesterol; +smoker; PVD,
• Meds: insulin; metformin; glyburide; hctz;
Rosiglitazone
Ddx