If we play the odds, we are obliged to focus our attention on the acute coronary syndrome. Although it is not an acute coronary syndrome, can it still be fatal diagnosis. Believe me when I say that you do not want to come to work and have someone say, "Hey, remember that the patient you so the other day ... because these conversations never positively not, but that they sent you a thank you note. More commonly, it is that the patient was admitted to another hospital with a bad, came back with something bad or dead!
I developed the mnemonic "PAPPA" to identify the main causes of chest pain. The first two, "PA" or "pappa" has to do with the heart. The next two, "PP," has to do with the lungs. And the last "A" is an aneurysm.
P is as acute Pericarditis is A coronary syndrome (or acute myocardial infarction) P Pneumothorax; P is Pulmonary Artery Embolism (A) is the Aneurysm.
When you assess a patient with chest pain, there are two key points: you need a system for patient assessment, as well as a system of objective evaluation: EKG/ECG and cardiac enzymes.
You must be a master in the 12 lead ECG/EKG interpretation. Can you remember the reasons for us ST segment that can mimic an acute myocardial infarction? I can not stress this enough, and if you have sleeping through this article, you need to wake up for these points: the chest pain is a risky business. You need a system to use 100% of the time in any patient who presents with chest symptoms. It must be reproducible and easy to use. Ask "who is your PAPPA." This works, I swear by it, you must then be strong on evaluation 12 lead EKG/ECG. There is no greater law suits and then a missed myocardial infarction. 25% of missed myocardial infarctions read due to miss ECG/ECGs. Sharpen you EKG/ECG skills!
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