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Symptom
dx.
Clinical Reference
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I have a symptom
Management
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Fractures & dislocations
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ECG
Interpretation guide
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Bedside ultrasound
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Step-by-step guides
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Chest Pain
Resuscitation and Universal Approaches
Approach to Unresponsive Patient
Approach to Airway Obstruction And Stridor
Approach to Acute Respiratory Distress With Impending Failure
Approach to Peri-arrest Hypotension
Approach to Post Resuscitation Care After Rosc
Approach to Cardiac Arrest Rhythms, Pea, Asystole
Approach to Cardiac Arrest Rhythms, Vf, Pulseless Vt
Approach to Severe Agitation With Safety Risk
Approach to Procedural Sedation
Chest and Cardiovascular
Approach to Pacemaker And Icd Related Presentations
Approach to Acute Limb Ischemia And Leg Pain
Approach to Suspected Deep Vein Thrombosis Symptoms
Approach to Hypertension
Approach to Chest Pain
Approach to Palpitations And Tachyarrhythmia Symptoms
Approach to Bradycardia Symptoms
Approach to Syncope And Presyncope
Approach to Syncope With Neurologic Concern
Approach to Unilateral Leg Swelling
Approach to Bilateral Leg Swelling
Approach to Calf Pain And Swelling
Respiratory
Approach to Wheezing, Undifferentiated
Approach to Wheezing In Infants
Approach to Stridor And Upper Airway Symptoms
Approach to Dyspnea
Approach to Aspiration Event
Approach to Cough
Approach to Hemoptysis
Approach to Upper Respiratory Infection Symptoms
Approach to Suspected Pulmonary Embolism Presentation
Approach to Smoke Inhalation Concern
Approach to Smoke Exposure And Inhalational Injury
Abdominal and Gastrointestinal
Approach to Abdominal Distension
Approach to Abdominal Pain, Undifferentiated
Approach to Acute Abdominal Pain (general)
Approach to Suspected Incarcerated Or Strangulated Hernia
Approach to Pancreatitis Concern
Approach to Biliary Colic And Cholecystitis Concern
Approach to Appendicitis Concern
Approach to Diverticulitis Concern
Approach to Rectal Pain And Anorectal Complaints
Approach to Dysphagia And Food Bolus Impaction
Approach to Foreign Body Ingestion
Approach to Refractory Vomiting And Recurrent Vomiting Syndromes
Approach to Cannabis Associated Hyperemesis
Approach to Upper Gastrointestinal Bleeding Symptoms (melena)
Approach to Lower Gastrointestinal Bleeding And Hematochezia
Approach to Constipation And Obstipation
Approach to Diarrhea
Approach to Acute Hepatitis And Jaundice Concern
Approach to Right Upper Quadrant Pain
Approach to Epigastric Pain
Approach to Left Upper Quadrant Pain
Approach to Right Lower Quadrant Pain
Approach to Left Lower Quadrant Pain
Approach to Suprapubic Pain
Renal and Urinary
Approach to Oliguria And Anuria
Approach to Catheter Related Urinary Complaints
Approach to Dialysis Patient Presentations
Approach to Flank Pain And Renal Colic Concern
Approach to Urinary Retention
Approach to Hematuria
Approach to Scrotal Pain
Neurologic
Approach to Transient Neurologic Deficits
Approach to Acute Aphasia And Speech Disturbance
Approach to Acute Confusion And Delirium
Approach to Postictal State And Seizure Recurrence Concern
Approach to Seizure
Approach to Acute Vision Loss
Approach to New Tremor And Involuntary Movements
Approach to Headache
Approach to Vertigo
Approach to Acute Weakness Or Numbness
Approach to Gait Instability And Ataxia
Back and Neck
Approach to Atraumatic Back Pain
Approach to Sciatica And Radicular Back Pain
Approach to Back Pain With Neurologic Deficit, Cauda Equina Concern
Approach to Back Pain With Fever Or Immunosuppression, Spinal Infection Concern
Approach to Atraumatic Neck Pain
Approach to Neck Pain After Trauma
Approach to Neck Pain With Meningismus Concern
Approach to Acute Torticollis
Women's Health, Pregnancy, and GU
Approach to Vaginal Discharge
Approach to Hyperemesis Gravidarum Concern
Approach to Hypertensive Disorders Of Pregnancy Symptoms
Approach to Postpartum Hemorrhage Concern
Approach to Postpartum Infection Concern
Approach to Sexual Assault Medical Evaluation Overview
Approach to Pelvic Pain
Approach to Vaginal Bleeding, Nonpregnant
Approach to Vaginal Bleeding In Pregnancy
Approach to Pelvic Pain In Pregnancy
Approach to Post Procedure Or Post Abortion Complications Concern
Infectious Disease and Fever Syndromes
Approach to Fever In The Immunocompromised Patient
Approach to Fever With Rash
Approach to Animal Bites And Rabies Risk Assessment
Approach to Tick Exposure And Tick Borne Illness Concern
Approach to Sepsis Concern Without Clear Source
Approach to Soft Tissue Infection Concern
Approach to Abscess And Skin Infection Concern
Approach to Sore Throat
Approach to Sore Throat And Pharyngitis Symptoms
Approach to Meningitis
Approach to Envenomation And Bites
Allergy and Dermatology
Approach to Pruritus Without Rash
Approach to Contact Dermatitis And Eczema Flare
Approach to Herpes Zoster Concern
Approach to Drug Eruption Concern And Severe Cutaneous Reaction Red Flags
Approach to Urticaria
Approach to Angioedema Concern
Approach to Unexplained Bruising Or Bleeding Symptoms
Musculoskeletal and Extremities
Approach to Shoulder Pain
Approach to Elbow Pain
Approach to Wrist Pain
Approach to Hand Pain
Approach to Hip Pain
Approach to Knee Pain
Approach to Ankle Pain
Approach to Foot Pain
Approach to Cast Or Splint Complication Symptoms
Approach to Wound Check And Suture Related Visits
Approach to Joint Swelling And Monoarthritis
Approach to Suspected Septic Joint Presentation
Approach to Suspected Tendon Rupture Presentation
Approach to Limp Or Refusal To Bear Weight
Trauma and Wounds
Approach to Motor Vehicle Collision Evaluation
Approach to Chest Wall Trauma And Rib Injury
Approach to Blunt Abdominal Trauma Evaluation
Approach to Penetrating Trauma Evaluation
Approach to Pediatric Minor Head Trauma
Approach to Pediatric Head Trauma
Approach to Facial Lacerations And Dental Trauma
Approach to Hand Lacerations With Tendon Injury Concern
Approach to Puncture Wounds And Retained Foreign Body Concern
Approach to Electrical Injury
Approach to Burn Injury
Approach to Fall Evaluation
Approach to Assault And Interpersonal Violence Evaluation
Approach to Eye Trauma And Hyphema Concern
ENT, Eye, Dental
Approach to Dysphagia And Odynophagia
Approach to Throat Pain
Approach to Ear Pain
Approach to Foreign Body In Ear Or Nose
Approach to Vision Loss Complaint
Approach to Flashes And Floaters
Approach to Atraumatic Eye Pain
Approach to Red Eye
Approach to Dental Abscess Concern
Approach to Post Extraction Pain And Complications
Endocrine, Metabolic, and Abnormal Labs
Approach to Hyperglycemia
Approach to Hypoglycemia
Approach to Hyponatremia Symptoms
Approach to Hyperkalemia Symptoms
Approach to Hypokalemia Symptoms
Approach to Rhabdomyolysis Concern
Approach to Anticoagulation Related Abnormal Coagulation Studies
Approach to Acute Kidney Injury And Elevated Creatinine Referral
Approach to Symptomatic Anemia Concern
Toxicology and Behavioral
Approach to Undifferentiated Overdose
Approach to Opioid Toxicity
Approach to Opioid Withdrawal
Approach to Alcohol Intoxication
Approach to Alcohol Withdrawal
Approach to Stimulant Toxicity
Approach to Pediatric Ingestion
Approach to Carbon Monoxide Exposure
Approach to Inhalational Or Chemical Exposure
Approach to Suicidal Ideation And Self Harm Risk Assessment
Approach to Acute Psychosis And Mania Symptoms
Approach to Anxiety And Panic Symptoms
Approach to Capacity Assessment And Safe Disposition
Approach to Behavioral Escalation And Restraint Considerations
Pediatrics
Approach to Fever In The Neonate And Young Infant
Approach to Pediatric Fever By Age 0 To 28 Days
Approach to Pediatric Fever By Age 29 To 60 Days
Approach to Pediatric Fever By Age 2 To 24 Months
Approach to Pediatric Respiratory Distress
Approach to Croup And Stridor In Children
Approach to Pediatric Dehydration
Approach to Pediatric Abdominal Pain
Approach to Febrile Seizure
Approach to Rash In The Child
Approach to Poor Feeding And Lethargy In The Infant
Approach to Vomiting In The Child
Approach to Diarrhea In The Child
Approach to Pediatric Trauma Evaluation
Approach to Brief Resolved Unexplained Event In The Infant And Apparent Life Threatening Event Concern
Approach to Lethargy And Altered Mental Status In The Child
Environmental and Exposure
Approach to Heat Illness
Approach to Hypothermia And Cold Exposure
Approach to Frostbite Concern
Approach to Drowning And Submersion Injury
Chest Pain
POCUS
Procedures
Calculators
Resuscitation
ECG Guide
Back
Clinical Assessment Checklist
Browse categories and answer follow-up questions to refine your symptom profile.
History
Context and timeline
Pattern overview
▶
Time of onset
Course
Duration of episodes
Frequency
First episode
Recurrent similar episodes
Baseline functional capacity
Change from baseline
OPQRST
Onset
▶
Sudden onset
Gradual onset
At rest onset
Exertional onset
Provocation and palliation
▶
Exertional trigger
Emotional stress trigger
Pleuritic trigger
Positional trigger
Postprandial trigger
Relief with rest
Relief with antacid
Relief with nitroglycerin
Quality
▶
Pressure
Tightness
Burning
Sharp
Tearing
Crushing
Region and radiation
▶
Substernal
Left chest
Right chest
Epigastric
Radiation to arm
Radiation to jaw
Radiation to back
Radiation to shoulder
Severity
▶
Peak severity
Current severity
Worst severity
Timing
▶
Intermittent pattern
Constant pattern
Morning predominance
Night predominance
Associated symptoms
Symptom cluster
▶
Dyspnea
Diaphoresis
Nausea
Vomiting
Syncope
Presyncope
Palpitations
Cough
Hemoptysis
Fever
Leg swelling
Neurologic deficit
Dysphagia
Special populations
Context modifiers
▶
Pregnancy or postpartum status
Pediatric age
Older adult
Immunocompromised
Anticoagulation use
Cocaine or stimulant exposure
Alarm Features
Immediate escalation triggers
Resuscitation triggers
▶
Airway compromise
SpO2 less than 90 percent despite oxygen
Respiratory fatigue
SBP less than 90 mmHg
Shock index greater than 1
Altered mental status
Persistent severe pain with instability
Ventricular tachycardia
Ventricular fibrillation
Symptomatic bradycardia
High risk historical features
Life threat clues
▶
Exertional chest pain
Chest pain with syncope
Pain radiating to back
Pleuritic chest pain with dyspnea
Chest pain after forceful vomiting
Cocaine related chest pain
Recent PCI or CABG
Known aortic disease
High risk exam findings
Exam red flags
▶
New focal neurologic deficit
Pulse deficit
Arm blood pressure differential
New diastolic murmur
Signs of heart failure
Unilateral absent breath sounds
Pericardial tamponade signs
Vital sign danger thresholds
Concerning vitals
▶
SBP less than 90 mmHg
SBP greater than 180 mmHg with symptoms
HR greater than 120
HR less than 40 with symptoms
RR greater than 30
SpO2 less than 90 percent
Temperature 38.0 C or higher
Medications
Current and recent medications
Medication reconciliation
▶
Antiplatelets
Anticoagulants
Beta blockers
Calcium channel blockers
Nitrates
Statins
Diuretics
Diabetes medications
High risk and interacting classes
Interaction risks
▶
PDE5 inhibitors
NSAIDs
QT prolonging agents
Stimulants
Hormonal therapy
Medication contraindications relevant to likely therapies
Contraindication screen
▶
Aspirin allergy
Active bleeding
Recent intracranial hemorrhage
Severe aortic stenosis history
Severe asthma with aspirin sensitivity
Diet
Intake and exposures
Recent changes
▶
Poor oral intake
Dehydration risk
High caffeine intake
Energy drink intake
Alcohol intake
Large fatty meal trigger
Symptom related triggers
Food pattern clues
▶
Postprandial chest burning
Supine worsening
Relief with upright posture
Review of Systems
Cardiopulmonary
Key symptoms
▶
Dyspnea
Orthopnea
PND
Edema
Palpitations
Syncope
Cough
Hemoptysis
Gastrointestinal
Key symptoms
▶
Heartburn
Regurgitation
Dysphagia
Odynophagia
Epigastric pain
Hematemesis
Infectious and inflammatory
Key symptoms
▶
Fever
Chills
Myalgias
Pleuritic pain
Recent URI symptoms
Neurologic
Key symptoms
▶
Focal weakness
Vision change
Speech change
Severe headache
Collateral History and Family History
Collateral source and reliability
Collateral details
▶
Source identity
Reliability concerns
Witnessed events
Family history
Inherited and early disease
▶
Premature coronary artery disease
Sudden cardiac death
Known cardiomyopathy
Known channelopathy
Venous thromboembolism
Aortic aneurysm or dissection
Risk Factors
Atherosclerotic and cardiac risk
CAD risk profile
▶
Age risk
Diabetes mellitus (E11.9)
Hypertension (I10)
Hyperlipidemia (E78.5)
Tobacco use disorder (F17.200)
Prior CAD (I25.10)
Prior MI (I21.9)
Prior stroke (I63.9)
CKD (N18.9)
Thrombosis and PE risk
VTE risk profile
▶
Prior PE (I26.99)
Prior DVT (I82.409)
Recent surgery
Recent immobilization
Active cancer (C80.1)
Estrogen exposure
Pregnancy or postpartum
Long distance travel
Aortic and structural risk
Aortic risk profile
▶
Known aortic aneurysm (I71.9)
Known connective tissue disorder
Bicuspid aortic valve history
Uncontrolled hypertension
Substance and exposure risk
Tox and stimulant risk
▶
Cocaine exposure
Amphetamine exposure
Carbon monoxide exposure risk
Differential Diagnosis
Life threatening
Cannot miss diagnoses
▶
Acute coronary syndrome (I20.0)
▶
Exertional pressure pattern
Diaphoresis
STEMI (I21.3)
▶
Persistent pain
ST elevation pattern on ECG
Aortic dissection (I71.00)
▶
Sudden severe pain
Radiation to back
Pulse deficit
Pulmonary embolism (I26.99)
▶
Pleuritic pain
Dyspnea
Tachycardia
Tension pneumothorax (J93.0)
▶
Unilateral absent breath sounds
Hypotension
Cardiac tamponade (I31.4)
▶
Hypotension
JVP elevation
Esophageal rupture (K22.3)
▶
Severe pain after vomiting
Toxic appearance
Common
High frequency diagnoses
▶
Stable angina (I20.9)
▶
Exertional pattern
Relief with rest
GERD (K21.9)
▶
Burning quality
Postprandial trigger
Costochondritis (M94.0)
▶
Reproducible chest wall tenderness
Movement related
Anxiety and panic (F41.0)
▶
Hyperventilation
Paresthesias
Pneumonia (J18.9)
▶
Fever
Cough
Less common
Lower frequency diagnoses
▶
Pericarditis (I30.9)
▶
Positional relief
Pleuritic quality
Myocarditis (I40.9)
▶
Viral prodrome
Troponin elevation without obstructive CAD
Hypertensive emergency (I16.1)
▶
Severe BP elevation
End organ symptoms
Herpes zoster (B02.9)
▶
Dermatomal pain
Rash onset later
Biliary disease (K80.20)
▶
RUQ pain
Postprandial trigger
Mimics and pitfalls
Diagnostic traps
▶
Normal initial ECG in ACS
Early troponin negative ACS
Atypical presentations in older adult
Atypical presentations in diabetes
Past Medical History
Cardiovascular history
Cardiac background
▶
Prior MI
Prior PCI
Prior CABG
Heart failure (I50.9)
Valvular disease
Arrhythmia history
Congenital heart disease
Vascular and thrombotic history
Vascular background
▶
Prior PE
Prior DVT
Known thrombophilia
Prior aortic aneurysm
Procedures and devices
Implanted and prior procedures
▶
Pacemaker
ICD
Recent cardiac catheterization
Recent endoscopy
Physical Exam
General and hemodynamics
Stability assessment
▶
Appearance
Work of breathing
Perfusion
Mental status
Skin diaphoresis
Cardiovascular
Cardiac findings
▶
Heart rate and rhythm
Murmur
New diastolic murmur
JVP
Peripheral edema
Peripheral pulses
Pulse symmetry
Respiratory
Lung findings
▶
Breath sounds
Unilateral decreased sounds
Wheeze
Crackles
Respiratory effort
Chest wall and musculoskeletal
Localizing findings
▶
Reproducible tenderness
Pain with movement
Rib deformity
Vascular and neurologic
Dissection and embolic signs
▶
Limb ischemia signs
Focal neurologic deficit
Arm blood pressure differential
Lab Studies
Cardiac biomarkers
Troponin strategy
▶
High sensitivity troponin local protocol dependent
Serial delta testing local protocol dependent
False negatives in early presentation
Basic and targeted labs
Core labs by context
▶
CBC for anemia or infection
Electrolytes for arrhythmia risk
Creatinine for contrast planning
Glucose for metabolic contributors
Coagulation and thrombosis
Thrombotic evaluation
▶
D dimer for low to intermediate PE probability
D dimer limitations in pregnancy
INR and aPTT if anticoagulated
Additional labs by differential
Conditional labs
▶
BNP or NT proBNP for heart failure support
Lactate for shock
Lipase for epigastric pain pattern
Pregnancy test for reproductive age
Imaging
Scoring Systems
Risk tools and pathways
▶
HEART score for suspected ACS
▶
Intended setting ED chest pain with possible ACS
Not intended for clear STEMI
Low risk disposition local protocol dependent
EDACS for suspected ACS
▶
Intended setting ED chest pain with possible ACS
Requires serial troponin strategy local protocol dependent
TIMI risk score for UA and NSTEMI
▶
Intended setting confirmed or strongly suspected ACS
Less validated for undifferentiated ED chest pain
Wells criteria for PE
▶
Intended setting suspected PE
Combine with D dimer in low probability
PERC rule for PE
▶
Intended setting very low pretest probability
Not for moderate to high suspicion
Aortic dissection detection risk score
▶
Intended setting suspected dissection
Combine with D dimer local protocol dependent
MRI
MRI indications and limits
▶
Cardiac MRI for myocarditis evaluation
Limited ED availability
Contraindications include non compatible implanted devices
Patient instability limits transport
CT
CT pathways
▶
CTA chest for aortic dissection concern
▶
Contrast nephropathy risk assessment
Requires BP and pain control when possible
CTPA for PE concern
▶
Pregnancy shared decision local protocol dependent
Contrast allergy mitigation local protocol dependent
CT chest for alternate pathology
▶
Pneumonia complication
Mass concern
Ultrasound
POCUS applications
▶
Focused cardiac ultrasound for pericardial effusion
LV function gross assessment
RV strain clues in PE
Lung ultrasound for pneumothorax
IVC size and collapsibility limitations
Ultrasound limitations
▶
Operator dependence
Poor windows in COPD or obesity
Special Tests
Bedside and procedural tests
Targeted bedside tools
▶
Point of care glucose for altered status
Peak flow in wheeze pattern
Ambulatory oxygen saturation with exertion when stable
Provocative and specialty testing
Downstream testing planning
▶
Stress testing not for unstable chest pain
Coronary CT angiography local protocol dependent
Echocardiography for wall motion abnormalities
Echocardiography interpretation pearls
▶
New regional wall motion abnormality supports ischemia
Normal echo does not exclude ACS early
ECG
Acquisition and timing
ECG workflow
▶
First ECG within 10 minutes for chest pain
Repeat ECG with recurrent pain
Repeat ECG after initial nondiagnostic when suspicion persists
Ischemia patterns
High risk findings
▶
ST elevation
ST depression
New T wave inversion
Hyperacute T waves
New LBBB pattern with ischemic symptoms local protocol dependent
STEMI equivalents and special patterns
Critical patterns
▶
Posterior MI pattern
Right ventricular infarct pattern
Wellens pattern
De Winter pattern
Arrhythmias and conduction
Rhythm threats
▶
Ventricular tachycardia
Atrial fibrillation with RVR
High grade AV block
Brugada pattern
Assessment
Problem representation
Working syndrome
▶
Chest pain with concern for ACS
Chest pain with concern for PE
Chest pain with concern for aortic syndrome
Chest pain with infectious concern
Chest pain with musculoskeletal features
Risk stratification
ACS risk tier
▶
High risk ECG changes
Troponin elevation
Hemodynamic instability
Refractory pain
Heart failure signs
PE risk tier
▶
Hemodynamic instability
Hypoxia
RV strain findings
Aortic risk tier
▶
Dissection risk features present
Neuro deficit
Malperfusion signs
Diagnostic uncertainty
Alternate diagnoses
▶
Need for serial evaluation
Need for repeat ECG
Need for repeat biomarkers
Plan
First 5 minutes
Time critical actions
▶
Cardiac monitor
Pulse oximetry
Blood pressure cycling
IV access
ECG within 10 minutes
Point of care glucose when indicated
Oxygen if SpO2 less than 90 percent
Immediate cardiology activation for STEMI pattern
Diagnostic sequencing
Test pathway
▶
Serial ECG strategy
Serial troponin strategy local protocol dependent
Chest radiograph for alternate thoracic pathology
PE pathway using Wells and PERC when appropriate
Dissection pathway using risk features and CTA when indicated
Therapeutics by syndrome
Suspected ACS
▶
Aspirin PO 160 mg to 325 mg chewed unless contraindicated
Nitroglycerin SL 0.4 mg every 5 minutes
▶
Maximum 3 doses
Avoid if SBP less than 90 mmHg
Avoid if RV infarct concern
Avoid if PDE5 inhibitor use
Analgesia if persistent pain
▶
Fentanyl IV 25 mcg to 50 mcg titrated
Avoid hypotension
Anticoagulation and P2Y12 local protocol dependent
Suspected PE
▶
Anticoagulation if high suspicion and low bleeding risk local protocol dependent
Thrombolysis pathway for massive PE local protocol dependent
Oxygen targets SpO2 92 percent or higher
Suspected aortic dissection
▶
Immediate CTA if stable enough
Pain control with opioid titration
HR control target 60 or less local protocol dependent
▶
Esmolol IV bolus and infusion local protocol dependent
SBP target 100 mmHg to 120 mmHg local protocol dependent
▶
Nicardipine infusion if needed local protocol dependent
Pericarditis pattern
▶
NSAID therapy local protocol dependent
Colchicine local protocol dependent
Avoid anticoagulation if large effusion concern
Monitoring and reassessment loop
Reassessment cadence
▶
Repeat vitals within 30 minutes for unstable features
Repeat pain score after interventions
Repeat ECG with symptom change
Escalate level of care if rising oxygen need
Consultation
Specialty triggers
▶
Cardiology for ischemia pattern
CT surgery or vascular for dissection concern
Pulmonary or ICU for massive PE concern
GI or surgery for esophageal rupture concern
Disposition
ICU criteria
Critical care admission
▶
Hemodynamic instability
Ongoing vasopressor requirement
Refractory hypoxia
Ventricular arrhythmia
Massive PE concern
Dissection with instability
Inpatient admission criteria
Admission triggers
▶
Troponin elevation
Dynamic ECG changes
High risk chest pain features
New heart failure
Myocarditis concern
Pericardial effusion with symptoms
Observation pathway criteria
Chest pain observation
▶
Low to intermediate risk ACS after initial evaluation
Serial ECG and troponin plan in place
No ongoing unstable features
Discharge criteria
Copy
Safe discharge
▶
Low risk stratification with serial testing completed local protocol dependent
Pain controlled
Normal or stable vitals
No concerning ECG changes
Reliable follow up
Return precautions understood
Discharge Instructions
Copy discharge instructions
Copy
Summary
▶
You were evaluated in the emergency department for chest pain
Your testing today did not show an emergency cause that requires admission
Medications
▶
Take medications as prescribed
Avoid taking erectile dysfunction medicines with nitroglycerin
Activity
▶
Avoid strenuous activity until follow up if symptoms were exertional
Do not drive if you feel faint
Follow up
▶
Primary care follow up within 1 to 3 days
Cardiology follow up timing local protocol dependent
Return to emergency department immediately
▶
Chest pain that is worse
Chest pain with shortness of breath
Chest pain with sweating
Chest pain with fainting
New weakness
New trouble speaking
New severe back pain
Coughing blood
New one sided leg swelling
References
Guidelines and decision tools
Core sources
▶
American Heart Association and American College of Cardiology guideline for chest pain evaluation 2021
European Society of Cardiology guideline for acute coronary syndromes 2023
European Society of Cardiology guideline for pulmonary embolism 2019
American Heart Association scientific statement on aortic dissection 2022
ACEP clinical policy for suspected non ST elevation ACS in the ED 2018
HEART score validation studies 2008 to 2017
PERC rule derivation and validation studies 2004 to 2008
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.
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Chest Pain