MedicalCC: Chest pain
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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