Emergency Medicine at HCMC
I. History and Physical
A. Cardiac risks – known
CAD (prior MI), HTN, smoker, diabetes, male, post-menopausal female,
family history, and lipids.
B. Detailed HPI of this CP episode
C. Any prior stress tests, angiography or echo on the patient (these
can be found on IRIS or in the patient's old charts)
D. Complete exam concentrating on CV and Lung exam, check for signs of
trauma or to see if the chest pain is reproducible. A rectal needs to
be done for signs of GI bleed as the patient may receive heparin or thrombolytics.
II. Work-up (needs to be discussed with senior or staff)
A. EKG – check
to see if the patient has an old EKG to compare (often the EKG tech
or NA can get you a copy of the old one/ or their
should be one in the chart)
B. ASA and pain control should be addressed while the patient is being
examined and tests ordered
C. CXR – d/w senior/staff but general rule is that all CP being
admitted needs a CXR or if you have a suspicion of another cause of
the CP
D. Labs – admission cardiac patients need CBC with platelets,
panel 3, PTT, PT, Troponin +/- CK
III. Treatment in ED
A. ASA – cardiac cause suspected give them
an aspirin unless they can clearly state they had one en route or
in the last few hours
B. Pain control – this is a priority. D/w senior/staff as to
approach, but do not let a ?cardiac CP sit with pain. Nitro x 3 then
MS IV is the general approach, but this needs to be tailored to the
patient.
C. All CP need to be on oxygen and on a monitor.
D. Further treatment such as heparin or nitro drip needs to be addressed
individually.
III. Admission
A. Need to go to a monitored bed for rule out MI.
B. Team – Blue medicine if not a family practice or renal patient.
C. If the patient is on a nitro drip or any cardiac drip other than
heparin they need to go to the CCU.
D. Be sure the patient has had a CXR, appropriate labs, an aspirin,
and is pain free.
For more information contact Richard
O. Gray MD.
Emergency
Medicine main page
Copyright © 2000 HCMC Emergency Medicine. All rights reserved.
Manual last modified: Wednesday May 07, 2003.
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