Chest pain decision tree.
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Begin ACLS and transport to ER
| NO
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Are VS normal?
| YES
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Is this an acute problem?
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YES
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YES
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YES
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Are there any "red flag" sx/sxs?
(Ex. "crushing" CP, radiation of pain, diaphoresis, dyspnea, cyanosis, respiratory distress, dizziness, syncope)
| NO
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Get an EKG:
Are there any ST changes, arrhythmias, or changes from a baseline EKG?
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Is it likely skin related?
(Ex. visible rash, itching, skin changes)
| YES
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DDx:
Cellulitis
Herpes Zoster
| YES
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Consider diagnostics:
Culture
Biopsy
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NO
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YES
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Is it likely GI related? (Ex. burning CP, change of sxs with eating, abdominal pain)
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Get more in-depth hx to determine likely etiology
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Is it likely Psych related?
(Ex. stress, known hx, hyperventilating)
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Possible in office tx:
Wound care
Abx cream
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YES
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YES
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DDx:
GERD
PUD
Esophageal spasm
Pancreatitis
Gallbladder dysfxn
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Is it likely Pulmonary related?
(Ex. wheezing, cough, SOB)
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Is it likely MSK related?
(Ex. worse with palpation, trauma to the area, bruising)
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DDx:
Anxiety
Panic attack
Depression
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YES
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YES
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YES
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YES
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Consider diagnostics:
Endoscopy
Ultrasound
H. pylori
CMP
Amylase
Lipase
CBC
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DDx:
PNA
PTX
Pleurisy
PE
Pulmonary HTN
COPD
Asthma
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DDx:
Costochondritis
OA
Muscle strain
Contusion
Trauma
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Consider diagnostics:
PHQ-9
GAD-7
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YES
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YES
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YES
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YES
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Possible office tx:
IV fluids
Pain meds
PPI/H2
Abx
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Consider diagnostics:
CXR
Chest CT
CBC
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Consider diagnostics:
X-ray
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Possible office tx:
Breathing exercises
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YES
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YES
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Possible office tx:
Nebulizer
O2
Abx
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Possible office tx:
Heat
Ice
Ibuprofen/APAP
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