Chest pain triage...
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Chest pain triage...
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We have been struggling with this issue recently regarding triaging patients with chest pain in the emergency department particularly those who are discharged home. I'm interested to see that the
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Forums » Open clinical » Cardiology » Chest pain triage...
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Chest pain triage...
posted at 3/8/2012 4:25 PM BST
on bmj.com
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Posts: 897
First: 17/6/2011 Last: 17/6/2013 |
We have been struggling with this issue recently regarding triaging patients with chest pain in the emergency department particularly those who are discharged home. I'm interested to see that the shortcuts section of the BMJ features a NEJM paper about using cardiac CT in this cohort - I personally think that this increases tests but may not change outcome that much - does anyone use cardiac CT in their ED? sadian |
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Re: Chest pain triage...
posted at 3/8/2012 11:26 PM BST
on bmj.com
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Posts: 3005
First: 10/3/2009 Last: 19/6/2013 |
May I suggest doctors actually palpate the chest as this may reduced the knee-jerk reaction of chest pain = IHD. It is lack of basic clinical application which leads to erroneous conclusions. |
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Re: Chest pain triage...
posted at 4/8/2012 11:15 PM BST
on bmj.com
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Posts: 3059
First: 27/3/2012 Last: 13/6/2013 |
I do agree that having cardiac CT may not change the outcome. Instead repeat ECGs or CTMT or having cardiospecific enzyme study like troponin I would add more to the diagnosis alongwith a proper clinical examination. |
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Re: Chest pain triage...
posted at 5/8/2012 8:00 AM BST
on bmj.com
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Posts: 1012
First: 15/7/2011 Last: 15/6/2013 |
If I may comment. I have dealt with a number of cases where patients have attended Emergency Departments with chest pain, been assessed and sent home a common feature emerges. Whilst they have taken cardiac enzymes, Troponins, ECG etc the experts examining the case constantly criticise that the examining Doctor did not do a satisfactory physical examination and employ their stethoscope - or at least record that they did. It may or may not have made a difference to the outcome but reliance on 'tests' is not satisfactory. Odyyseus point above is very important. |
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Re: Chest pain triage...
posted at 5/8/2012 9:24 AM BST
on bmj.com
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Posts: 2135
First: 12/3/2010 Last: 18/6/2013 |
Kirked, While the 'compleat examination' may be the physician's sine qua non {Enough with the Latin. Ed.}, what did the experts think the missing chest exam indicated? If present, did it 'merely' show diligence and competence, or (like Odysseus' point) were clinical signs missed? John |
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Re: Chest pain triage...
posted at 5/8/2012 10:19 AM BST
on bmj.com
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Posts: 1012
First: 15/7/2011 Last: 15/6/2013 |
In Response to Re: Chest pain triage...: Kirked, While the 'compleat examination' may be the physician's sine qua non {Enough with the Latin. Ed.}, what did the experts think the missing chest exam indicated? If present, did it 'merely' show diligence and competence, or (like Odysseus' point) were clinical signs missed? John Posted by John D Case One John, as I understand it the Paramedics who initially brought the patient in insisted that the patient was cold, clammy and peripheraly cyanosed. No such reference was made to these symptoms by the Casualty officer. Virtually no physical examination was recorded other than 'abdomen soft'.The patient was discharged home and 2 hours later the same Paramedic crew attended and the patient was in extremis. |
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Re: Chest pain triage...
posted at 5/8/2012 2:44 PM BST
on bmj.com
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Posts: 607
First: 8/6/2011 Last: 17/6/2013 |
The fact that the corect clinical examination must precede any possible paraclinical exame , is something understood by all doctors . You can not make a diagnosis without clinical exanination ' using only paraclinics. |
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Re: Chest pain triage...
posted at 5/8/2012 4:31 PM BST
on bmj.com
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Posts: 897
First: 17/6/2011 Last: 17/6/2013 |
I agree with the above - do we not do the basics because we rely too heavily on tests and think that the tests will answer everything? If we don't get the basics right there is no point in the 'gadgets'. sadian |
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