This document discusses pain, specifically chest pain, and how to assess and evaluate chest pain. It defines pain and describes characteristics of chest pain such as location, quality, radiation, and associated symptoms. It provides an O-X format for assessing chest pain and evaluating for potential cardiac causes versus non-cardiac causes. Key assessments include vital signs, cardiovascular risk factors, history of previous cardiac issues, and characteristics of the chest pain. The goal is to determine the cause of chest pain through history and physical exam and initiate appropriate treatment.

1. PAIN

2.  Pain is an unpleasant feeling often caused by
intense or damaging stimuli
 Pain is an unpleasant sensory and emotional
experience
associated with
actual or potential tissue damage, or
described in terms of such damage

3. CHEST
PAIN

4. O – X Format

5.  ABCs-- CAB
 Age
 Vital signs
 Oxygen therapy
 Cardiac monitoring
 History of previous heart
conditions
 Diabetes
 Hypertension
 Stroke
 Medications

6. Position
 Left chest
 Right Chest
 Sub sternal
 Epi gastric
 Mid back
 Generalized
Provocation
Cold
Heat
Stress

7. Pressure/squeezing
Discomfort
Burning
Sharp
Aching

8. Left/right arm
Neck, Jaw
Anywhere at all

9.  Nausea vomiting
 Diaphoresis
 Anxiety
 Shortness of breath
 Dizziness

10.  When did the pain begin?
 When did the pain end?
 Does it come and go?

11.  Pain scale 0-10 (0 - NO pain to 10 worst
pain or discomfort)
Signs of non cardiac pain

12. V: Variation
 Variation with deep inspiration
 Pain increased or changed with position
W: Worse
 With palpation
X: eXisting
 Pain lasts a few fleeting seconds

13.  Costochondritis : painful inflammation of the
cartilage that attaches the ribs to the sternum
Common cause of chest pain in kids and teen.
 Girls more –
 sharp stabbing pain ( like Heart Attack)
 It goes off in 2- 3 days – or last bit longer
 Cause ?? …. related to injury .. physical strain –
heavy lift – exercise --- repeated coughing
 Pain go worse when child take deep breathing –
coughing ..

14. Other Assessments….

16.  Why does pain during a heart attack
tend to radiate toward the left side
of the body

18.  Many organs in the body have very few
specific pain receptors (nociceptors).
 the heart has very few or no nociceptors, the
brain has a difficult time interpreting
irritation as pain.
 The nerves from your heart join with other
organs from the general area and follows the
same nerve pathways to your spinal cord
then to your brain.
 This creates a sensation of generalized
discomfort commonly interpreted as pressure
or a dull ache to the generalized area,
typically the left arm and neck

19.  Assessments………………
Putting together ……………
What we will do ??????

20.  Initial Assessment: CAB ……….ABC
 Determine whether the pain may be cardiac ---
the other origin
 Consider -----History
 Presence of CV risk factors
 H/O IHD –
 Previous treatments
 Previous investigations – for chest pain

21. Determine the cause of Chest Pain
 Brief targeted History – physical assessment
 Admitted before – pneumonia, GB, COPD,
U. Angina,-- DM
 Describe chest pain --- character–
scale –PQRST
 Initiate appropriate intervention

22. Vital signs: Baseline ----------
• B Cardia----- poor function of heart
• Tachy Cardia – Inadequate perfusion
• ^BP – result of pain --
• ^workload of heart /myocardial O2
requirement
Head to toe assessment : use senses –
--- Look ---Listen ---- Feel—

23.  Neurological assessment ( brief) ..ask
personal questions , Squeeze your hand, Press feet
against hard surface ( all can be done while checking
VS/monitoring
 Heart …monitoring ---
Rhythm– rate – Auscultation---
 Lungs –Resp effort – dyspnea, /tachypnea
Breath sounds– clear– crackly– wheezing
Pain on inspiration ---
 O2 sat--- >94%
 Abdomen– distended, Bowel movement,
nauzea, vomiting. Pain begin -…
 after eating(GERD)
 relieved by eating

24. If no definite diagnosis –
treat as of cardiac origin
 Investigations –
 Medications