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Project: Ghana Emergency Medicine Collaborative
Document Title: Approach to Acute Chest Pain
Author(s): Rockefeller Oteng ...
Attribution Key
for more information see: http://open.umich.edu/wiki/AttributionPolicy

Use + Share + Adapt
{ Content the ...
Pathophysiology	
  
•  Soma1c	
  Pain	
  fibers	
  
–  Dermis	
  and	
  parietal	
  
pleura	
  innerva1ons	
  
–  These	
  ...
Pathophysiology	
  
•  Soma1c	
  Pain	
  fibers	
  
–  Pain	
  is	
  usually	
  easily	
  
described	
  
–  Precisely	
  lo...
Pathophysiology	
  
•  Several	
  modifying	
  factors	
  to	
  the	
  pain	
  
sensa1on	
  
•  Co-­‐morbidi1es,	
  age,	
...
Ini1al	
  Approach	
  
•  In	
  our	
  evalua1on	
  we	
  are	
  concerned	
  with	
  the	
  
“acute	
  chest	
  pain”	
  ...
Ini1al	
  Approach	
  
•  Given	
  the	
  poten1ally	
  serious	
  concerns	
  the	
  
pa1ent	
  should	
  be	
  addressed...
Ini1al	
  Approach	
  
•  Vital	
  signs	
  should	
  be	
  assessed	
  and	
  repeated	
  at	
  
regular	
  intervals	
  ...
Ini1al	
  Approach:	
  History	
  
• 
• 
• 
• 
• 
• 

Are	
  you	
  having	
  discomfort?	
  
How	
  would	
  you	
  descr...
Ini1al	
  Approach:	
  History	
  
• 
• 
• 
• 
• 
• 
	
  

Frequency	
  of	
  the	
  discomfort?	
  
Time	
  of	
  onset	
...
Physical	
  Examina1on	
  
•  Your	
  primary	
  survey	
  is	
  a	
  focused	
  examina1on	
  
and	
  will	
  allow	
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Physical	
  Examina1on	
  
•  Once	
  you’ve	
  evaluated	
  for	
  acute,	
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threatening	
  condi1ons	
  and	
  ...
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GEMC- Approach to Acute Chest Pain- for Residents

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This is a lecture by Rockefeller Oteng from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.

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GEMC- Approach to Acute Chest Pain- for Residents

  1. 1. Project: Ghana Emergency Medicine Collaborative Document Title: Approach to Acute Chest Pain Author(s): Rockefeller Oteng (University of Michigan), MD 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1  
  2. 2. Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. 2   To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  3. 3. Pathophysiology   •  Soma1c  Pain  fibers   –  Dermis  and  parietal   pleura  innerva1ons   –  These  enter  the  spinal   cord  at  specific  levels   and  arranged  in  a   dermatomal  pa=ern   •  Visceral  Pain  fibers   –  Found  in  internal  organs   such  as  heart  and   esophagus  and  blood   vessels   –  Enter  the  cord  at   mul1ple  levels  and   “share”  parietal  cortex   space  with  the  soma1c   fibers   3  
  4. 4. Pathophysiology   •  Soma1c  Pain  fibers   –  Pain  is  usually  easily   described   –  Precisely  located     –  Described  as  a  sharp   sensa1on   •  Visceral  Pain  fibers   –  Imprecisely  localized   –  Difficult  to  describe   –  OJen  described  as   aching,  discomfort,   heaviness   –  OJen  misinterpreted   because  the  pain  is   referred  to  a  different   area  by  the  adjacent   soma1c  nerve   4  
  5. 5. Pathophysiology   •  Several  modifying  factors  to  the  pain   sensa1on   •  Co-­‐morbidi1es,  age,  gender,  medica1ons,   drugs,  alcohol   •  “Cultural  and  language  difference”   5  
  6. 6. Ini1al  Approach   •  In  our  evalua1on  we  are  concerned  with  the   “acute  chest  pain”   •  What  recent  event  or  change  has  brought   them  to  the  hospital?   •  How  is  the  pa1ent  experiencing  the   discomfort?   •  The  ini1al  approach  is  based  on  the  fact  that   there  are  life  threatening  causes  of  chest   discomfort   6  
  7. 7. Ini1al  Approach   •  Given  the  poten1ally  serious  concerns  the   pa1ent  should  be  addressed  quickly  and   systema1cally   •  IV,  O2,  Monitor   •  Immediate  life  threats  should  be  addressed   systema1cally:     •  Airway   •  Breathing   •  Circula1on   7  
  8. 8. Ini1al  Approach   •  Vital  signs  should  be  assessed  and  repeated  at   regular  intervals   •  While  you  direct  the  rest  of  the  team  you  then   begin  your  direct  ques1oning  and  primary   survey   •  What  types  of  ques1ons  would  you  like  to   ask?     8  
  9. 9. Ini1al  Approach:  History   •  •  •  •  •  •  Are  you  having  discomfort?   How  would  you  describe  the  discomfort?   Where  is  the  discomfort?   Does  it  radiate  anywhere?   Any  aggrava1ng/allevia1ng  factors?   Any  associated  discomfort?   –  Diaphoresis,  nausea,  vomi1ng,  cough,  fevers   9  
  10. 10. Ini1al  Approach:  History   •  •  •  •  •  •    Frequency  of  the  discomfort?   Time  of  onset  or  acute  worsening?   Has  there  been  any  progression?   History  of  Cardiopulmonary  disease?   Risk  factors  for  cardiopulmonary  disease?   Family  history  of  cardiopulmonary  disease?   10  
  11. 11. Physical  Examina1on   •  Your  primary  survey  is  a  focused  examina1on   and  will  allow  you  to  start  interven1ons   •  What  is  part  of  your  primary  survey?   –  General  appearance  of  pa1ent   –  Assessment  of  the  airway   –  Assessment  of  breathing  (  listen  to  the  pulmonary   sounds)   –  Assessment  of  Circula1on  (listen  to  heart  sounds)   11  
  12. 12. Physical  Examina1on   •  Once  you’ve  evaluated  for  acute,  life   threatening  condi1ons  and  reassessed  vital   signs  then  con1nue  to  the  secondary  survey   •  During  this  examina1on,  you  should  look  the   other  body  systems  and  peripheral  signs  that   can  be  associated  with  acute  cardiopulmonary   issues.   12  

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