|Parent skills||Medical Patient Assessment|
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|Use the acronym and practice asking the relevant questions to determine the patient's likelihood of exposure to the altering agent until comfortable with the work flow|
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There are several things to keep in mind in evaluating the patient whose presenting complaint is chest pain, but in the prehospital setting, your primary focus is rapid determination of the likelihood that the patient is having a life threatening condition such as an Acute Myocardial Infarction (AMI), a pulmonary embolism (PE), or acute aortic dissection (AAD) and is in need of rapid transport.
Having a structured and systematic approach to these cases will help you develop and streamline the diagnostic workup and more quickly determine transport priority. Chest pain must always be considered both serious, and cardiac in nature until proven otherwise. You should not hesitate to start high flow oxygen therapy before completing your assessment.
Signs and Symptoms[edit | edit source]
OPQRST is a mnemonic acronym used by many medical professionals during the Signs and Symptoms step of the SAMPLE history to elicit the time course, severity and quality of a patient's pain to help with the differential diagnosis.
|Mnemonic component||Questions to ask||Findings|
|Onset||"What were you doing when it started?"||Pain brought on by exertion that subsides is more characteristic of angina, whereas gradually increasing pain should increase your suspicion of an AMI. Abrupt onset of maximal pain is highly suspicious of an AAD|
|Provocation or Palliation||"Does anything make it worse? Anything makes it better?"||Repositioning a patient or resting does not tend to help chest pain caused by an AMI, PE or AAD. If repositioning or rest helps alleviate the pain, it may be from another source. Chest pain that is worse with breathing is suspicious for a PE|
|Quality of pain||"Can you describe it to me? Is it sharp, dull, constant, intermittent?"||For cardiac involvement, in addition to pain, often patients will describe it as a pressure, discomfort, or tightness. Not all AMIs present with the classic "substernal chest pain". "Tearing" pains are more common in AD|
|Region and Radiation||"Where exactly does it hurt? Does the pain extend anywhere else?"||Myocardial infarction and Angina can both produce pain that radiates to the arms and jaw. In women the pain can often feel like indigestion. Any of these could have a cardiac source. Pain in the back or abdomen is more suggestive of AAD|
|Severity||"On a scale of 1 to 10, how much does it hurt?"||Low levels of pain to not rule out an AMI or a PE - use the pain scale to help determine whether the pain is getting better or worse. Recheck with the patient after oxygen or nitroglycerin administration.|
|Time||"How long has this been going on? How has this progressed over time?"||Angina is typically short lived, and the pain resolves with rest. Pain that does not resolve, or worsens over time should increase your index of suspicion that this is a serious issue requiring immediate transport.|
Medications[edit | edit source]
In the "M" section of SAMPLE (Medications) specifically ask about medications for heart conditions or medications that could induce clotting including
- Birth control pills
Pertinent Medical History[edit | edit source]
In the "P" section of SAMPLE (Pertinent Medical History), ask the patient about both their history of Cardiopulmonary disease as well as risk factors for cardiopulmonary disease including:
- High cholesterol
- Family history
If a PE is suspected, be sure to ask about recent air travel or prolonged sedentary periods, calf swelling/pain or any coagulation irregularities.