What to do when the nurse calls you to attend patient with CHEST PAIN !

Another common reason why a house officer called by nurses is to attend patients with chest pain. The key to provide an optimum care for such patients is to monitor their symptoms, ECGs and cardiac biomarkers at regular interval from the onset of symptom.

Rule of Thumb :

  1. Do Not assume the nurse is wrong
  2. Keep the telephone conversation as short as possible - just ask for the vital infos
  3. Remember you will attend to the patient No Matter what !


Common mistakes that could cost lives :

1. Verbally Ordering ( by phone ) drugs and treatment without attending to patient .
2. Not attending to patient with chest pain if pain score is low.
3. Thinking about cardiac causes alone for Chest pain.
4. Relying heavily on imaging and lab investigation results for diagnosis.
5. Inability to prioritize case causing delay in attending to patient with chest pain.
6. Failure to seek help from senior colleagues.


Correct measures :

1. Attend to patient

2. Obtain brief history about the complaint with differential diagnosis in mind
    - Respiratory causes - eg. Pneumothorax, pneumonia with pleuritis 
    - Cardiac causes - eg. Acute Coronary syndrome (ACS) , Aortic dissection
                                       Pulm. Embolism, pericarditis, Myocarditis
    - GI causes - eg. severe dyspepsia / GERD, acute cholecystitis, esophageal rupture
    - Musculoskeletal pain - Costochondritis
    
3. Examine patient - focused CVS ans RS examination

4. Tests and Investigations - 

- SERIAL ECGs - Always do serial ECGs for any patient suspected to 
                                have ACS.

- SERIAL Cardiac markers - depending on risk factors and ECG changes

- CXR

- Basic blood investigations if  tests has not been done recently

5. Order treatment stat to alleviate chest pain - eg. Sublingual GTN (for ACS) and consider analgesics - Do not be satisfied till you pin down the cause for his chest pain.
Alleviation of pain is a supportive treatment not the goal of treatment.

6. Inform senior / superior and manage the patient's diagnosis accordingly