If we play the odds, we are obligated to focus our attention toward the acute coronary syndrome. Even if it's not an acute coronary syndrome, it may still be lethal diagnosis. Trust me when I say that you do not want to come to work and have someone say to you, "Hey, remember that patient you saw the other day ... because these conversations never end positively, it's not that they sent you a thank you note. More commonly it is that the patient was admitted to another hospital with something.bak, bad, or came back with something.bak, bad, or died!
I developed the mnemonic "PAPPA" to identify the main causes of chest pain. The first two, "PA" or "PAPPA" have to do with the heart. The next two, "PP," have to do with the lungs. And the last "A" is an aneurysm.
P is as Acute Pericarditis is A coronary syndrome (or acute myocardial infarction) P is Pneumothorax is A Pulmonary embolism P is Aneurysm.
When evaluating a patient with chest pain, there are two key points: you need a system of patient evaluation as well as a system of objective evaluation: the EKG/ECG and cardiac enzymes.
You have to be a master at 12 lead EKG/EKG interpretation. Are you able to recall the causes of os ST segment that may mimic an acute myocardial infarction? I cannot say this enough ", a, and if you have been sleeping through this article, you need to wake up for these points: chest pain is a risky business. You need a system to apply 100% of the time in any patient that presents with chest symptoms. It has to be reproducible and easy to apply. Ask, "Who's Your PAPPA." This works, I swear by it. Then, you have to be strong at evaluating the 12 lead EKG/ECG. There are no larger law suits then missed a myocardial infarction. 25% of myocardial infarctions are missed due to miss read EKG/ECGs. EKG/ECG Sharpen you skills!
