Evaluating a Patient With Chest Pain

Evaluating a Patient With Chest Pain

Ngozi,

Great post! Evaluating a patient with chest pain is a diagnostic challenge for persons who practice emergency medicine. The chest pain syndrome includes symptoms that may be due to acute myocardial ischemia. It consists of various complaints, such as dizziness, nausea, weakness, jaw pain, and chest pain. More than 5% of all ED visits are because of complaints related to chest pain. Despite several investigations into the risk stratification scores and the diversity in the testing strategies and diagnostic algorithms, more than 2% of patients with chest pain syndrome will be discharged to go home and later diagnosed with acute myocardial infarction within one week. Because of this, patients who present to the emergency department with chest pain or similar complaints ought to receive priority triage with minimal evaluation time delay and a 12-lead ECG. The symptoms of chest pain are often vague. Thus, The practitioner must ask pertinent questions to characterize the pain. The patient should describe the pain as either tearing, sharp, or aching; the location of the pain; whether the pain is substernal specific to a particular side of the chest; if any are alleviating or exacerbating factors; whether there is pain improvement when the patient leans forward or worsens when taking in a deep breath (Fanaroff et al., 2015).

Chest pain is sometimes confused with abdominal pain, especially if it is epigastric or occurs higher than the abdominal quadrants. Thus, the practitioner should remember that the presentations may be atypical, classic, or immediate between arbitrary descriptions. Rapid evaluation of patients with chest pain should be done to determine the pain etiology. An ECG and a focused physical and history examination are the critical interventions needed (Haasenritter et al., 2015).

References

Fanaroff, A. C., Rymer, J. A., Goldstein, S. A., Simel, D. L., & Newby, L. K. (2015). Does this patient with chest pain have an acute coronary syndrome?: the rational clinical examination systematic review. Jama, 314(18), 1955-1965.

Haasenritter, J., Biroga, T., Keunecke, C., Becker, A., Donner-Banzhoff, N., Dornieden, K., … & Bösner, S. (2015). Causes of chest pain in primary care–a systematic review and meta-analysis. Croatian Medical Journal, 56(5), 422-430.

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Evaluating a Patient With Chest Pain

During a medical diagnosis, a doctor may be required to investigate a patient’s symptoms by differentiating between two or more conditions through a process known as differential diagnosis. Using an elimination process, the method enables medical practitioners to distinguish between diseases or conditions with similar signs. Every possible cause of a patient’s symptom is considered and rejected based on differential diagnosis. A healthcare provider must collect subjective and objective data from a patient to ensure its effectiveness. Collected data should then be put in a list showing the symptoms. The same list should be used to give a possible diagnosis (First, 2016).
Identify three different DD processes used in clinical practice.
Chest pain process- when a patient has chest pain, it can be due to many underlying factors. Some causes may be mild, while others may be extreme and need immediate medical attention.
Headache process- headaches can be tricky for a doctor to identify its cause. A doctor may be required to run several tests to ascertain the cause of the headache. A headache may pose a severe health risk to a patient if left unchecked.
Stroke process- when diagnosing and treating a stroke, many medical practitioners utilize differential diagnostic methods (Siegent Haler, 2017).
Describe the risks/benefits of these three processes.
Utilizing the three processes is essential as it helps in clinical reasoning. The processes involve developing a list of conditions likely causing a patient’s symptoms. Appropriate testing allows a medical practitioner to provide a diagnosis and rule out potential bias possibilities (Lim, 2016).

References:

First, M. B. (2016). DSM-5 handbook of differential diagnosis. American Psychiatric Pub.

Lim, E. K., Oster, A. J., & Rafferty, A. T. (2016). Churchill’s pocketbook of differential diagnosis (Ed.).

Siegent Haler, W. Differential diagnosis in internal medicine: from symptom to diagnosis, 2017 Edition. APPL, aprinta druck, Wemding, Germany