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