Chest pain is a diverse topic. Patients who present to the ER with chest pain could be having a life-threatening cardiac or respiratory condition.
As a nurse, your job is to figure out: is the patient having a heart attack? An aortic aneurysm? A pulmonary embolism? Etc. or is the patient experiencing a non-life-threatening condition such as costochondritis?
It can be hard to discern, so here are some pro tips to help.
If a patient presents to the ER with complaint of chest pain, you will want to ask:
- When it started
- What does it feel like
- Is there anything that makes it better or worse
There are a few types of chest pain that stand out, and if a patient describes their chest pain using any of these key words, you should be suspicious of certain etiologies.
Tearing, Ripping, or Shearing Chest Pain
If a patient says they are having sudden tearing, ripping or shearing chest pain, You want to be concerned they may be having an aortic dissection.
What should you do? Take a BP in both arms.
- if BP is greater than 20 mmHg between arms this patient needs to get to a CT scanner
Pressure, Tightness, or Crushing Chest Pain
If a patient says they feel like an elephant is sitting on their chest, there is a squeezing or tightness in their chest, or they feel a crushing chest pain, you should be suspicious of a myocardial infarction.
What should you do? Get an EKG.
- This is when getting an EKG immediately counts.
- If the patient is having a STEMI (ST-Elevated MI) the quicker you diagnose this and get that patient to a cath lab, the better the outcome.
- Make sure you know how to read this EKG. It’s pretty important. Here is a book that I use to help interpret EKGs called ECG Interpretation: An Incredibly Easy Pocket Guide.
Sharp Chest Pain with Shortness of Breath
If a patient says they have a sharp chest pain and they are short of breath, you will want to be concerned for a pulmonary embolism.
What should you do? You still get an EKG first, if negative for a STEMI, get a pulse oximetry reading, start a right sided large bore IV and draw a D-Dimer.
- If the D-Dimer is positive, get the patient to a CT scanner for a CT-PE.
Now, it is very important to note that these are not hard and fast rules, rather they are warning signs that give you clues to help diagnose. Someone may not have any symptoms or may have abnormal signs/symptoms. Someone may have searing chest pain and NOT have a dissection. You have to look at the whole picture and use these clues to help guide a workup for patients.