A 58-year old male presents with a complaint of severe chest pain over the past hour. He did not call 911 “because I don’t have the money for an ambulance.”
S- As the patient is complaining of severe chest pain, It would be best to document his description of the pain using OLDCART as a reference. Are there any other symptoms like sweating, N/V, any SOB, any recent illness (Cough or fever). Also, ask him if this has happened before? does he have any other diagnosis? history of GI issues? family history of cardiac or GI issues? Do you smoke, drink, or use other illicit drugs? Taking anything prescribed? When is the last time you ate and what was it?
O- What is the patient’s LOC? What are his vitals? What is his color? We should listen to the lungs and heart sounds. Does he look like he is having trouble breathing? EKG should be done and this will determine the treatment. Check biomarkers for cardiac involvement.
A- Likely diagnosis is Myocardial infarction vs GERD. The defining symptoms are pain in the chest. An EKG will be able to differentiate between the two as well as the specific symptoms like onset, activity prior to onset, location of the pain, and perfusion. (Thygesen, 2007)
P- If the EKG (ST elevation) , CKMB, and troponin, and myoglobin indicate cardiac involvement then the next step would be to increase perfusion. If however, the results return normal then consider ordering an ultrasound of the abdomen to check for abnormalities as well as CBC and ESR rate to check for infection or inflammation. (Thygesen, 2007) either way, further testing will need to be completed in order to assess for the cause whether it is cardiac or GI related. Pain management is crucial as well. Educating the patient on pain management, and once a cause is found, implementing new preventative interventions to manage the condition will help convalescence. (AHA, 2017)
American Heart Association. (2017, March 31). Treatment of a heart attack. www.heart.org. https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack
Thygesen, K., Kristian Thygesen Search for more papers by this author, Alpert, J. S., Joseph S. Alpert Search for more papers by this author, White, H. D., Harvey D. White Search for more papers by this author, Search for more papers by this author, and TASK FORCE MEMBERS: Chairpersons: Kristian Thygesen (Denmark), and Biomarker Group: Allan S. Jaffe, Chaitman, and E. C. G. G. B., Underwood, and I. G. R., Bassand, and I. G. J.-P., and Clinical Investigation Group: Paul W. Armstrong, and Global Perspective Group: Philip A. Poole-Wilson, and Implementation Group: Lars C. Wallentin Coordinator (Sweden), and ESC COMMITTEE FOR PRACTICE GUIDELINES, Vahanian, and A., REVIEWERS, and D. O. C. U. M. E. N. T., & Morais, and J. (2007, October 19). Universal definition of myocardial infarction. Circulation. https://www.ahajournals.org/doi/10.1161/circulationaha.107.187397.
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