CHEST PAIN
H & P:
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Acute MI
Chest pressure, radiates, dyspnea, nausea, diaphoresis, CVD risk factors
GEN: Pallor, diaphoresis / CVS: Murmur, peripheral edema
Aortic dissection
Tearing pain, radiates, dyspnea, paresthesia, CVD risk factors
CVS: ↑BP, asymmetric BP, murmur / PVS: Limb ischemia, asymmetric pulses
Esophageal rupture
Hx prolonged vomiting, Hx instrumentation
GEN: Diaphoresis, subcutaneous emphysema / CVS: Crunching heart sound
Pericarditis
Sharp pleuritic pain, radiates, worse supine, recent infection, recent MI
GEN: ↓BP, tachycardia, fever / CVS: ↑JVP, ↓S1/S2, pulsus paradoxus, rub
Pneumothorax
Dyspnea, sharp pleuritic pain, Hx trauma, Hx instrumentation
GEN: Tachypnea, subcutaneous emphysema / RESP: ↓A/E, ↑percussion
Pulmonary embolism
SOB, pleuritic pain, hemoptysis, Sx, immobility, smoker, BCP, Ca, Hx DVT/PE
GEN: Tachypnea, tachycardia / PVS: Leg edema, erythema, heat, tenderness
Tamponade
Sharp pleuritic pain, dyspnea, orthopnea, Hx trauma
GEN: ↓BP, tachycardia, pallor, diaphoresis / CVS: ↑JVP, ↓S1/S2, pulsus paradoxus
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Investigation:
CBC, Lytes, Cr, BhCG, Trop, ECG, CXR, CT
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- HEART Score
- PERC
- Well's
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