Emergency physicians evaluate millions of patients who present with chest pain annually. How do you really know who are at no-risk and low-risk for acute coronary syndrome (ACS)?
There is unfortunately no perfect or simple answer.
It's all about risk stratification and knowing the insensitive nature of the history, physical, EKG, and diagnostic tests.
Here is another installment of the Paucis Verbis (In a Few Words) e-card series on the topic of Low Risk ACS Chest Pain from EM Clinics of North America.
Feel free to download this card and print on a 4'' x 6'' index card...
Trying to identify the low risk chest pain patient is the bane of the emergency physician's existence! Where is that star trek tricorder when you need it.
ReplyDeleteHere here, Craig. It is the bane of my existence along with a triage sheet complaint of "failure to thrive".
ReplyDeleteI've been meaning to look up data on the 'normal cath' patient for ages - cheers
ReplyDeleteChris
Chris: Yes, that "normal cath" info was been bugging me for years. Finally got around to looking it up.
ReplyDelete.
ReplyDeletecan someone please clarify the aspirin rule. what if they use aspirin as prophylaxis, for example, baby aspirin daily? Does this count??
ReplyDeleteFrom my understanding, this is the "aspirin paradox" based on the merged databases of the TIMI trials. Yes that means if they are on daily aspirin (and compliant with the medication), they would get a point. There's some theory that those with aspirin resistance portend a worse outcome. There are likely other confounders, since people who are on aspirin tend to be older and with greater co-morbidities.
ReplyDeleteRich JD, Cannon CP, Murphy SA, Qin J, Giugliano RP, Braunwald E. Prior aspirin use and outcomes in acute coronary syndromes. J Am Coll Cardiol. 2010 Oct 19;56(17):1376-85.
http://www.ncbi.nlm.nih.gov/pubmed/20946994