Chest Pain
Resources to Review Prior to Conference

Goals and Objectives
Goals
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Trainee will demonstrate competence in the initial evaluation and basic management of patients with chest pain
Objectives
Trainee will be able to:
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List and describe six life-threatening causes of chest pain:
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Acute coronary syndromes
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Aortic dissection
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Cardiac tamponade
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Esophageal perforation
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Pneumothorax (tension)
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Pulmonary embolism
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Describe the typical presentation and alarm symptoms for life-threatening causes of chest pain
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List and describe the rationale for initial diagnostic tests for life-threatening causes of chest pain, which may include:
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Evaluation of vital signs
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Auscultation
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ECG
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Chest X-ray
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Ultrasound
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CT scan
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List and describe the indications for potential initial therapeutic interventions for patients with chest pain, which may include:
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Aspirin
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Anticoagulation
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Thrombolysis
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Cardiac catheterization and percutaneous coronary intervention (PCI)
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Emergent blood pressure management
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Needle decompression / Thoracostomy
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Pericardiocentesis
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Additional Resources
Acute Coronary Syndromes
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See: Acute Coronary Syndromes (EM Fundamentals)
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Aortic Dissection
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General
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Acute Nontraumatic Thoracic Aortic Dissection (ACEP Clinical Policy 2014) (pdf)
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Aortic Dissection Review (CoreEM 2014)
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Aortic Dissection (EMCrit 2013)
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Risk Stratification
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Systematic Review: ADD-RS + D-dimer (Acad Emerg Med 2020)
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ADvISED Trial: ADD-RS + D-dimer (Circulation 2018)
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ADD-RS: Aortic Dissection Detection Risk Score (MD Calc)​
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Ultrasound​
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US for Aortic Dissection (ALiEM 2014)​
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Esophageal Perforation
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Boerhaave Syndrome (LITFL 2019)
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Esophageal Perforation (EMDocs 2018)
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Pneumothorax
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General
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Pneumothorax (CDEM 2019)
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Spontaneous Pneumothorax (ANZ J Surg 2018)
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Ultrasound
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US for Pneumothorax (REBEL EM 2014)
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Decompression
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Needle Decompression for Tension Pneumothorax (EPMonthly 2014)
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Pulmonary Embolism
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Suspected Acute Venous Thromboembolic Disease (ACEP Clinical Policy 2018) (pdf)
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Acute Management of Pulmonary Embolism (ACC 2017)
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PE Treatment Options (EMCrit 2014)
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When the PERC Rule Fails (ALIEM 2014)
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D-Dimer Testing
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Age-adjusted D-dimer (MD Calc)
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Ultrasound​
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RV Strain (ACEP US)​
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Thrombolysis
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Thrombolysis for Submassive PE (LITFL 2019)
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Tamponade, Cardiac
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Acute Myopericardial Syndromes (EM:RAP 2021)
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Pericarditis and Tamponade (EM:RAP 2011)
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Acute Cardiac Tamponade (NEJM 2003)
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Ultrasound
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Pericardial Effusion vs. Tamponade (ALiEM 2019)​
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Pericardiocentesis
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Pericardiocentesis (HighlandEM US 2019)
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Pericardiocentesis (EM-in-5 2016)
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