Common calls for Interns Chest Pain
Tachypnea
Have a recent set of vitals
Vitals, evaluate volume status
Why are they hospitalized?
Consider things that kill (dissection, MI, PE)
UA, has there been fever, history
Consider a GI cocktail
CXR, I/O
Get: CXR, EKG, Enzymes
Consider EKG
See an ST elevation? Call the STEMI team, and nursing
Think Cardiac, pulm, fluid status, renal GI
If vitals meet SIRS
supervisor to get the staff for the cath lab Can give nitro paste and ASA, don’t load with Plavix
Patient falls
until you speak to the attending
See patient, vitals (HR, orthostatic)
Get pain under control, make sure vitals are stable
If they may have hit their head get a CT
Call attending for chest pain- MI or not
Xray if concern for injury (hit knee, etc.)
STEMI is urgent, get old info (caths, EKG’s, etc.) if it’s
Review meds (BP meds, if on blood thinners re -check
not a STEMI
INR even if you have one from t he day) Brace neck if concern of neck injury
6 beats of Vtach
Put on fall precautions
Symptomatic? EKG. Check electrolytes, H&H. Can wait until morning if
AMS
sleeping/asymptomatic
Check meds, electrolytes, CBC, vitals Think of stroke- neuro exam
HR jumps to 130 on tele
Consider ABG based on vitals
New vitals, EKG, go see patient
Consider UA, CXR, lactic acid, blood cultures, EKG Get accucheck
New onset Afib with RVR and stable BP
Elderly? Try not to give Ativan. Give morphine if in pain,
Think of etiology- CHF, PIRATES
or Haldol
CBC (infection, anemia) Mg, Phos, TSH, electrolytes
Seizure
EKG, enzymes
Ativan
Blood cultures, lactic acid, UA, ABG, CXR
Check prolactin if actively seizing
If unstable BP with pain- patient deteriorating,
CT after
synchronized shock without verset (due to low BP)
Fall precautions
Tx- can give multiple multiple boluses of Amiodarone (150) and drip of 0.1 mg/kg for 6 hours, then 0.5 mg/kg
Can’t sleep
May use Cardizem 5 or 10mg and drip
Trazadone good in young healthy females
If pressure drops with CCB, give Ca glucuronate (usually
Avoid Ambien in older patients. Even if they’re o n it at
on drip)
home, there’s ↑risk of delirium delirium in an unfamiliar setting and while ill. Consider Restoril, Ramelteon, or maybe
PE- post-surgical
nothing.
Check with surgeon before anticoagulating Making calls- the attending can direct you who to consult. Call him/her first
