Professional Documents
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Chest Pain
Chest Pain
Chest Pain
CLINICAL PROTOCOL
Chest Pain
INTRODUCTION: Patients presenting with chest pain require rapid evaluation. Myocardial
ischaemia should be considered in all patients presenting with chest pain. Assessment of
pain type and referral, and response of pain to various interventions is important in
differentiating between cardiac and non-cardiac chest pain. If the pain is cardiac in nature it
is important to respond quickly to ensure the best possible outcome for the Pt.
DIFFERENTIAL DAIGNOSIS:
CVS CAUSES; AMI, unstable angina, aortic dissection, aortic aneurysm, pericarditis,
aortic stenosis, mitral valve prolapse.
RESP CAUSES; pulmonary embolism, pneumothorax, severe pneumonia.
GI CAUSES; oesophageal spasm or rupture, gastric reflux, indigestion, perforated
peptic ulcer.
Musculoskeletal causes.
Trauma or neoplasm.
Psychiatric causes.
Scope
Chest pain responsive to protocols
outlined within this CP.
Medical
Chest pain unresponsive to treatment
Practitioner
outlined within this CP.
+/ Evidence/suspicion of AMI or more
Nurse
serious cause of pain.
Practitioner
Initial Assessment and Interventions
Presenting
Relevant past medical Hx and
History
medication history
Known allergies
Pt. describes pain as squeezing,
pressing, constricting, and heavy in
central chest, +/- radiating to left
arm, neck or jaw.
Pt. may feel a sense of impending
doom.
Outcomes
Identify patients suitable for
NP clinical protocol. Refer
unsuitable pts. to current GP.
Identify patients not suitable
for NP CP and redirect to usual
GP care +/- ED
Outcomes
Identify patients not suitable
for NP CP and redirect to usual
GP care +/- ED
Nurse Practitioner
CLINICAL PROTOCOL
Chest Pain
Physical
examination
Pain
assessment
Pathology
Imaging
Investigations
Troponin, FBC, U&E, CK, LFTs
CXR if respiratory cause suspected.
Outcomes
Refer to GP for ongoing
management.
Diagnosis of cause of pain and
application of correct treatment
regime.
Outcomes
Ensure patient understands
problem, treatment and follow
up.
Nurse Practitioner
CLINICAL PROTOCOL
Chest Pain
appointment.
Patient
Education
Nurse
e Practition
ner
CLINICA
AL PROTO
OCOL
Ch
hest Pain
Inittial
manag
gement
path
hway
Reassu
ure Pt.
Plac
ce Pt. in an upright
u
positio
on
Give O2 2-4 L/nasal cannula
c
if available.
If no resp
ponse to glyc
ceryl
trinitrate
refer to cu
urrent GP
for further advice and
d
ment.
managem
eriences a cardiac
c
If Pt. expe
arrest commence
c
b
basic
life
support/a
advanced life
e support
as per fac
cility protoco
ol.
r
to
Documenttation and referral
current GP, transfer to
t nearest
cy departme
ent.
Emergenc
Iff no response
e after 5 mins
s
Repea
at sublingual glyceryl trinittrate
Assess vittal signs
Iff no response
e after 5 mins
s
Repea
at sublingual glyceryl trinittrate
Assess vittal signs
If pain is unresolv
ved after 20 mins
m
(3 doses of glyc
ceryl trinitrate
e)
CAL
LL 000 FOR AN
A AMBULANC
CE
Administer analg
gesia if requ
uired
y if necessa
ary
Maintain airway
C
Continue
to reassure
r
Pt..
Nurse Practitioner
CLINICAL PROTOCOL
Chest Pain
Goals of Treatment
Relief of symptoms
Prevention of recurrence
Prevention of complications
Drug Formulary
FORMULARY
GLYCERYL TRINITRATE
ASPIRIN
Route: oral
within 30 minutes.
requirement.
coronary syndrome.
(esp. asthma).
Unexpected
representation
NP Clinical
Practice
Evaluative strategies
Review Patient Notes. Full audit of clinical
events.
NP Clinical Practice/Medical Report Audit
Nurse Practitioner
CLINICAL PROTOCOL
Chest Pain
Key Terms
NP Nurse Practitioner
CP Clinical Protocol
GP General Practitioner
S4 Schedule of the drug administration
act
References
1. Australian Medicines handbook (internet). 2011, Nov. Accessed 2011 Dec 1 at
http://www.amh.net.au
2. etg complete (internet). Melbourne: Therapeutic Guidelines Limited; 2011 Nov.
Accessed 2011 Dec 1 at http://etg.tg.com.au/ref/ref
Authorship, Endorsement and acknowledgement
This CP was originally written by:
Reviewed and authorised by:
Carol Jones
Dr. Frank Reedman Jones
Nurse Practitioner
MBBCh, DCH, DRCOG, FRACGP, FACRRM
Murray Medical Centre Mandurah
Murray Medical Centre: Primary Care
Physician