Management of Patient with Chest Pain

Question: Discuss about the Management of Patient with Chest Pain. Answer: Introduction: When a patient complaining of chest pain is brought into the healthcare system, the very first task that the health care professional present at the emergency room at that particular time requires to perfume is to conduct an evaluation of the patients condition. Initially the evaluation of the patient should be conducted by observation and by the inspection of his or her vital statistics (Parsonage, Cullen Younger, 2013). In case the patient is found to be stable, the triage process (as indicated in the ACEM guidelines) should be conducted, so as to estimate the severity of his or healthcare condition. The 12 LEAD electro cardiogram process (also known as ECG or EKG) should be performed next, besides making oxygen saturation available to the patient. In case the patient still complains of a persisting chest pain, he or she should be treated with Aspirin ( 300 mg 325 mg, depending on the age, gender and weight of the patient). Along with these, the blood pressure of the patient woul d be monitored, besides conducting blood tests like that of Full Blood Count (FBP), Urea and electrolytes (for measuring the kidney function of the patient), blood sugar level tests (BSL), along with the measurement of the troponin level for estimating the damage that has occurred to the heart. More often than not, a chest radiograph accompanies these tests (Than et al. 2014). In case it is found that the patient is not in a stable condition, the triage procedure should not be conducted: instead the patient should be immediately provided with oxygen saturation, following which the 12 LEAD EKG procedure would be conducted (Kong et al. 2012). The observation of the patients blood pressure should be conducted simultaneously with conducting the blood tests mentioned in the section above. However, as soon as the results of the EKG arrive, the same should be checked for determining any anomaly present in the ST elevation ( as anomalies in the ST elevation reflect infarction or myocardial ischaemia). The health practitioner should also check for the presence of any Left bundle branch block or LBBB, if present, in the EKG report (Haaf et al. 2013). The STEMI protocol should be referred to for finding the further interpretations of the same. In the next step, the clinical history of the patient should be documented, so as to collect information about all other ailments or physical conditions that the patient has (Backus et al. 2013). It is worth mentioning that the selection of the drugs to be prescribed to the patient varies largely with the other ailments and allergies that the patient suffers from, thus making the documentation of the clinical history of the patient one of the key processes of the entire process of treatment. The results of the troponin test conducted in the very first stage of the treatment process should have reached the health practitioner by this time. Bedside this, efforts are also directed towards the identification of the ACS risk features of the patient, along with the calculation off the EDAC scores of the same (Six et al. 2013) It is worth mentioning that the 12 LEAD electro cardiogram process is repeated in every 20 minutes and the reports are noted (with special emphasis on any changes in comparison with the test results observed previously) in case the patient complains of persisting chest pain (Than et al. 2014). Once the results of the troponin test and the ACS risks factors are available, decisions regarding the next phase of treatment are taken based on the following logic: Initial level of troponin is negative, ACS risks is low: The effective dosage of the medicine to be provided to the patient to be made after the results of the 2nd round of EKG and tropinin test arrive (Parsonage, Cullen Younger, 2013). Initial level of troponin is negative, ACS risks is not low: Cardiological review of the patient has to be conducted (Kong et al. 2012). Slightly raised level of troponin, undifferentiated level of risk group: The health practitioner should go ahead with further treatment of the patient (Haaf et al. 2013). Raised level of troponin, High risk group: The patient should be admitted in the medical assessment unit on an emergency basis (Kong et al. 2012). References Backus, B. E., Six, A. J., Kelder, J. C., Bosschaert, M. A. R., Mast, E. G., Mosterd, A., ... Monnink, S. H. J. (2013). A prospective validation of the HEART score for chest pain patients at the emergency department.International journal of cardiology,168(3), 2153-2158. Haaf, P., Reichlin, T., Twerenbold, R., Hoeller, R., Gimenez, M. R., Zellweger, C., ... Freese, M. (2013). Risk stratification in patients with acute chest pain using three high-sensitivity cardiac troponin assays.European heart journal, eht218. Kong, G., Xu, D. L., Body, R., Yang, J. B., Mackway-Jones, K., Carley, S. (2012). A belief rule-based decision support system for clinical risk assessment of cardiac chest pain.European Journal of Operational Research,219(3), 564-573. Parsonage, W. A., Cullen, L., Younger, J. F. (2013). The approach to patients with possible cardiac chest pain.Med J Aust,199(1), 30-4. Six, A. J., Cullen, L., Backus, B. E., Greenslade, J., Parsonage, W., Aldous, S., ... Than, M. (2013). The HEART score for the assessment of patients with chest pain in the emergency department: a multinational validation study.Critical pathways in cardiology,12(3), 121-126. Than, M., Aldous, S., Lord, S. J., Goodacre, S., Frampton, C. M., Troughton, R., ... Jardine, D. L. (2014). A 2-hour diagnostic protocol for possible cardiac chest pain in the emergency department: a randomized clinical trial