Chest pain- its one of the most common chief complaints in the ED and we need to be the experts on this. This podcast reviews how to get a good history of the patient’s chest pain, the relevant physical exam findings, how to work it up, and how to talk effectively to your consultants. Please email your comments and suggestions to firstname.lastname@example.org.
Update (7/16/2016)- A listener asked about the reference that patients who are on anticoagulation are at the same risk for PE as those who are not on anticoagulation. I admit this was something I was taught by my attendings during my residency but I did not look up. I did find this study that found that in the time span of 8 years at one hospital, 9% of their admissions for PE were patients who were already taking coumadin (http://www.ncbi.nlm.nih.gov/pubmed/23740364). So while it is possible to have an acute PE with a therapeutic INR, I cannot say that these patients are at the same risk as those who are not on anticoagulation based on what I could find in the literature. However, you should still pursue the diagnosis of PE in a patient on anticoagulation (even if they are therapeutic on coumadin) if you suspect it based on your history, physical, and other findings. These patients may need to be placed on different anticoagulation, possibly injectable low molecular weight heparin.
I plan on updating this episode in the near future to include new information on low risk chest pain rule outs using delta troponin testing in the ED as well as other developments in the world of chest pain workup. Stay tuned and thanks for listening.
Chest pain show notes (Word document)
Chest pain show notes (PDF)