Many of our patients suffer from “chest pain”. The true reasons vary from STEMI’s to seatbelts and from asthma to aortic dissection. As you begin to assess your patient and make your diagnosis, you then have to put the patient into categories. The Medical Assessment tab in ELITE asks for your Clinical Impression and Supporting Impressions.
STEMI’s and injuries are easy enough. They have a specific answer in the Impression list. Some of the other chest pain may be less obvious to categorize. The impressions were tweaked a bit to be more clear. Here are the ELITE choices if you patient has chest pain:
|CV-Chest Pain (Cardiac, angina,Non-STEMI)||Injury-Thorax (chest/upper back)|
|CV-Chest Pain (STEMI) of anterior wall||Pain-Chest (not cardiac or injury)|
|CV-Chest Pain (STEMI) of inferior wall|
|CV-Chest Pain (STEMI) of other sites|
The items labeled with CV (cardiovascular) are for suspected or known cardiac chest pain. If the patient has pain due to an injury, you should choose Injury-Thorax. If your patient has chest pain that isn’t specifically cardiac or injury related, you need to list “Pain-Chest”. Most BLS chest pain cases will choose either “Injury” or “Pain” since chest pain due to cardiac issues usually requires a monitor and further ALS treatments. There are numerous ALS causes of chest pain that are not cardiac or traumatic in nature so “Pain” can encompass pain that doesn’t fit elsewhere.
*** Unless the chest pain is directly caused by a known trauma, all providers should still complete a 12 lead for any patient complaining of chest pain (35 years and older at a minimum). ***
Please ensure that you review the lists of choices for the provider impressions. You should always choose the one item that drives your treatment the most or the most direct answer as the Primary Impression. Other supporting impressions will be Secondary Impressions. An example would include a patient with asthma having shortness of breath and chest pain due to tightness. The primary impression should be “Resp-Asthma Exacerbation” and a secondary impression can include “Pain-Chest (not cardiac or injury)”.
Stay tuned for future installments of How to Elite!