Assessment of the Patient with Acute Chest Pain - Flowchart

Assessment of the Patient with Acute Chest Pain - Flowchart

Assessment of the Patient with Acute Chest Pain - Flowchart Assessment of the Patient with Acute Chest Pain Assessment of the Patient with Acute Chest Pain

Flowchart

Acute chest pain

Acute chest pain

Acute chest pain

Antiplatelet and reperfusion therapy (Chapter 45)

Antiplatelet and reperfusion therapy (Chapter 45)

Antiplatelet and reperfusion therapy (Chapter 45)

End

End

End

Assess using ABCDE method
Key observations (Table 1.1)
ECG monitor, IV access
Oxygen if indicated
Relieve pain
Focused assessment (Table 7.1)
12-lead ECG, biomakers, CXR and other urgent investigation (Table 7.2)

Assess using ABCDE method
Key observations (Table 1.1)
ECG monitor, IV access
Oxygen if indicated
Relieve pain
Focused assessment (Table 7.1)
12-lead ECG, biomakers, CXR and other urgent investigation (Table 7.2)

Assess using ABCDE method
Key observations (Table 1.1)
ECG monitor, IV access
Oxygen if indicated
Relieve pain
Focused assessment (Table 7.1)
12-lead ECG, biomakers, CXR and other urgent investigation (Table 7.2)

Table 1.1

Table 7.1
Table 7.2

Acute coronary syndrome (ACS) with ST-segment elevation?
Consider differential diagnosis (Tables 7.3 and 7.4)

Acute coronary syndrome (ACS) with ST-segment elevation?
Consider differential diagnosis (Tables 7.3 and 7.4)

Acute coronary syndrome (ACS) with ST-segment elevation?
Consider differential diagnosis (Tables 7.3 and 7.4)

7.3 7.4

Yes

Yes

Yes

No

No

No

Review clinical features and results
Consider point-of-care echocardiography (Table 7.7)
Recheck biomakers

Review clinical features and results
Consider point-of-care echocardiography (Table 7.7)
Recheck biomakers

Review clinical features and results
Consider point-of-care echocardiography (Table 7.7)
Recheck biomakers

Table 7.7

Specific treatment

Specific treatment

Specific treatment

Diagnosis confirmed?

Diagnosis confirmed?

Diagnosis confirmed?

Yes

Yes

Yes

No

No

No

Reconsider:

ACS
Aortic dissection
Pulmonary embolism
Oesophageal rupture

Reconsider:

ACS
Aortic dissection
Pulmonary embolism
Oesophageal rupture

Reconsider:

ACS
Aortic dissection
Pulmonary embolism
Oesophageal rupture

ACS
Aortic dissection
Pulmonary embolism
Oesophageal rupture

Unlikely

Unlikely

Unlikely

Possible

Possible

Possible

Further tests (e.g. CT)

Further tests (e.g. CT)

Further tests (e.g. CT)

Diagnosis confirmed

Diagnosis confirmed

Diagnosis confirmed

Diagnosis excluded

Diagnosis excluded

Diagnosis excluded

Admit
Refer to cardiologist

Admit
Refer to cardiologist

Admit
Refer to cardiologist

Discharge outpatient investigation and follow-up if indicated

Discharge outpatient investigation and follow-up if indicated

Discharge outpatient investigation and follow-up if indicated

Low-risk clinical status and test results?

Low-risk clinical status and test results?

Low-risk clinical status and test results?

Yes

Yes

Yes

No

No

No