Trouble – Chest Pain in the ED


Chest pain is the archetypal ED presentation: one which presents frequently and usually has a benign cause, but could, just could, be the result of life threatening pathology. As Emergency Physicians we must look after these patients well and make sound decisions about their investigations and treatment and in this podcast Simon and I endeavour to give an introduction to how to approach them.

Using our EM maxim of “Rule Out the Worst Case Scenario” we have to actively rule out the potentially serious causes first and we would encourage you to approach these five systematically, using a focused history, examination and investigation to cross them off your differential diagnosis list:

• Acute Coronary Syndrome
• Pulmonary Embolus
• Pneumonia
• Pneumothroax
• Aortic Disssection

Clearly each of these conditions would be deserving of a podcast, or a series of podcasts, on their own (and in the fullness of time they will have them!). For now we need to concentrate on the classical features of each, whilst bearing in mind that the reason EM is so fascinating is that the patients don’t tend to read the textbooks (or listen to podcasts).

You can also watch the SEMEP video on chest pain here

Unsurprisingly there are lots of excellent resources on this topic available and these are just a few we would encourage you to explore

BMJ Learning (requires log in or Athens) Chest Pain of recet origin – assessment and diagnosis: in association with NICE

LITFL Chest Pain

BMJ Learning (requires log in or Athens) ECG in Chest Pain

Posted by Iain Beardsell

Dr Iain Beardsell. MBChB (Birm) FRCEM is section lead for podcasts. Editorial Board Member St Emlyn’s blog and podcast. He is a Consultant in Emergency Medicine at University Hospital Southampton and a Consultant in Pre Hospital Emergency Medicine. Iain qualified in 1998 and over the past 20 years has trained and practiced medicine in major teaching hospitals both in the UK and overseas. He has been a consultant at University Hospital Southampton for the past ten years, including a three year term as the unit’s Clinical Director. UHS is the main Major Trauma Centre for the South Coast region of England as well as the eighth largest hospital in the UK. Iain is also a highly regarded advisor to television medical dramas, including Casualty and Good Karma Hospital. An acclaimed speaker, Iain has spoken at international conferences in Australia, Ireland, Austria and Germany as well as across the UK. You will find him on twitter as @docib

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