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Oklahoma State Department of Health 01-2018Revised CHEST PAIN/PRESSURE Cardiac and non-cardiac conditions cause chest pain including angina, myocardial infarction, hyperventilation, anxiety, muscle strain, pulmonary embolism or dissecting aortic aneurysm. History: Risk factors for heart disease Past history of heart attack Past history of angina; treatment Determine time of onset Quality of pain, sharp, dull, aching, stabbing, burning etc. Location of pain Severity of pain (0-10 scale) Additional symptoms; shortness of breath, unexplained sweating, nausea, radiating to arms, neck or back, rapid heart rate with shortness of breath, cough that may produce blood-streaked sputum, fainting, Anxiety or panic attacks Medications (Nitroglycerin) Medication Allergies (aspirin) Assessment: Obtain vital signs o Listen to heart-rate, rhythm, lungs (for breath sounds) o Check pulse in all extremities and compare Assess for: o Shortness of breath o Skin condition (cold, clammy, sweaty) o Pain with cough or deep breathing o Sudden difficulty speaking, loss of vision, weakness, or paralysis of one side of the body Treatment: If the person is standing, assist them to a sitting or lying position Loosen tight clothing Assist individual with prescribed nitroglycerin tablet. They should not bite or chew nitroglycerin. It should be placed under the tongue to dissolve. Prescribed nitroglycerin may be taken as 1 tablet or spray under the tongue every 5 minutes up to 3 tablets in 15 minutes Encourage individual to chew a 325mg uncoated aspirin Call EMS: Unexplained chest pain lasting more than a few minutes New cases of chest pain Unresolved pain after their normal treatment Pain associated with fever and shortness of breath Reference WebMD. Chest Pain Treatment. Retrieved electronically October 13, 2017 at https://www.webmd.com/first-aid/chest-pain-treatment Chest Pain This Page Intentionally Left Blank.

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Chest Pain/Angina Humanresearchwiki Chest Pain/Angina
6/14/2016 Chest Pain/Angina HumanResearchWiki Chest Pain/Angina From HumanResearchWiki Contents 1 Introduction 2 Clinical Priority and Clinical Priority Rationale by Design Reference Mission 3 Initial Treatment Steps During Space Flight 4 Capabilities Needed for Diagnosis 5 Capabilities Needed for Treatment 6 Associated Gap Reports 7 Other Pertinent Documents 8 List of Acronyms 9 References 10 Last Update Introduction Cardiac chest pain, also known as angina, usually occurs secondary to deprivation of oxygen from an area of the heart, often resulting from an inability of the coronary arteries to supply adequate amounts of oxygen during a time of increased demand. The most common cause is atheromatous plaque which obstructs the coronary arteries.[1] NASA crewmembers are extensively screened to rule out coronary artery disease, but progression of previously subclinical and undetectable coronary artery disease may occur during a long duration mission. The initial care of cardiac chest pain is available on the International Space Station (ISS) and the crew is trained to evaluate and treat as needed (ISS Medical Checklist).[2] Clinical Priority and Clinical Priority Rationale by Design Reference Mission One of the inherent properties of space flight is a limitation in available mass, power, and volume within the space craft. These limitations mandate prioritization of what medical equipment and consumables are manifested for the flight, and which medical conditions would be addressed. Therefore, clinical priorities have been assigned to describe which medical conditions will be allocated resources for diagnosis and treatment. “Shall” conditions are those for which diagnostic and treatment capability must be provided, due to a high likelihood of their occurrence and severe consequence if the condition were to occur and no treatment was available.
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Shortness of Breath. History of the Present Illness
10/20/2006 Write-Up to be Graded Sarah Broom Chief Complaint: Shortness of breath. History of the Present Illness: Mr.--- is a previously healthy 56-year-old gentleman who presents with a four day history of shortness of breath, hemoptysis, and right-sided chest pain. He works as a truck driver, and the symptoms began four days prior to admission, while he was in Jackson, MS. He drove from Jackson to Abilene, TX, the day after the symptoms began, where worsening of his dyspnea and pain prompted him to go to the emergency room. There, he was diagnosed with pneumonia and placed on Levaquin 500 mg daily and Benzonatate 200 mg TID, which he has been taking for two days with only slight improvement. He then drove from Abilene back to Greensboro, where he resides, and continued to experience shortness of breath, right sided chest pain, and hemoptysis. He presented to an urgent care office in town today, and was subsequently transferred to the Moses Cone ER due to the provider’s suspicion of PE. The right-sided pain is located midway down his ribcage, below the axilla. This pain is sharp, about 7/10 in severity, and worsens with movement and cough. Pressing on the chest does not recreate the pain. He feels that the pain has improved somewhat over the past two days. The hemoptysis has been unchanged since it began; there is not frank blood, but his sputum has been consistently blood-tinged. The blood seems redder at night. The dyspnea has been severe, and it is difficult for him to walk more than across a room.
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KNOW the FACTS ABOUT Heart Disease
KNOW THE FACTS ABOUT Heart Disease What is heart disease? Having high cholesterol, high blood pressure, or diabetes also can increase Heart disease is the leading cause of your risk for heart disease. Ask your death in the United States. More than doctor about preventing or treating these 600,000 Americans die of heart disease medical conditions. each year. That’s one in every four deaths in this country.1 What are the signs and symptoms? The term “heart disease” refers to several The symptoms vary depending on the types of heart conditions. The most type of heart disease. For many people, common type is coronary artery disease, chest discomfort or a heart attack is the which can cause heart attack. Other first sign. kinds of heart disease may involve the Someone having a heart attack may valves in the heart, or the heart may not experience several symptoms, including: pump well and cause heart failure. Some people are born with heart disease. l Chest pain or discomfort that doesn’t go away after a few minutes. l Pain or discomfort in the jaw, neck, Are you at risk? or back. Anyone, including children, can l Weakness, light-headedness, nausea develop heart disease. It occurs when (feeling sick to your stomach), or a substance called plaque builds up in a cold sweat. your arteries. When this happens, your arteries can narrow over time, reducing l Pain or discomfort in the arms blood flow to the heart. or shoulder. Smoking, eating an unhealthy diet, and l Shortness of breath. not getting enough exercise all increase If you think that you or someone you your risk for having heart disease.
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Education Heart Palpitations
Education Heart Palpitations What are palpitations? Palpitations are an uncomfortable awareness of your heartbeat. You may feel that your heart is beating harder or faster than usual or that it is skipping a beat or two. Palpitations are common and often normal. They are a symptom, not a disease. However, it is important to determine their cause. How do they occur? Palpitations may be brought on by: exercise stress, anxiety, or fear smoking alcohol too much caffeine from coffee, colas, or tea anemia heart problems, such as mitral valve prolapse a thyroid problem medicines, such as diet pills and decongestants, or overdoses of such medicines as theophylline and antidepressants premenstrual syndrome (PMS) a lack of certain vitamins or minerals low blood sugar, or an insulin reaction in diabetics. What are the symptoms? Symptoms may include: thumping, pounding, or racing sensation in your chest fluttering sensation in your chest feeling of irregular beating or skipped beats. How are they diagnosed? Your health care provider will review your symptoms and examine you. You may have an electrocardiogram (ECG) or other tests to help find the cause. You may be given a heart monitor to wear at home. You may have an ultrasound test of the heart called an echocardiogram or an exercise stress test to see if heart problems are causing the palpitations. How are they treated? Treatment of palpitations depends on the cause. Most often, no treatment is needed because the heart is otherwise normal. Drinking less coffee or alcohol, or none at all, may be all you need to do.
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Chest Pain (Angina) What You Can Expect at the Hospital
PATIENT EDUCATION Chest Pain (Angina) What You Can Expect at the Hospital Chest Pain When To Call Your Nurse Your doctor wants you to have some tests to Call your nurse right away if you have any find out the cause of your recent heart event. of the following: These tests can tell your doctor what caused chest pain or pressure your pain. pain moving to arm, neck or jaw Angina (chest pain) happens when not enough blood flows to your heart muscle. This is a unexplained nausea (upset stomach), pressure or tightness in the chest. It is usually heartburn or both brought on by stress and goes away when the shortness of breath. stressful activity stops. Activity At the Hospital You will stay in bed until the EKG and blood You will be taken to a unit where your heart test results are known. You may be able to use rhythm will be checked with a the bathroom if you are able to be out of bed. heart monitor. A nurse will ask you for your health history You will slowly increase your activity from and do a physical exam. resting to walking. Your doctor may request cardiac rehabilitation. You will have an electrocardiogram (EKG). This test records the electrical activity of Food and Drink your heart. Your doctor will order heart-healthy food low — You will have small electrodes (discs) in saturated fat, salt and cholesterol. placed on your chest. You will not be able to have caffeine. — The electrical “waves” are shown on a This includes regular and decaffeinated coffee, monitor and printed on paper.
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Angina Symptoms Describe Angina As Feeling Like a Vise Is Squeezing Their Chest Or Feeling Like a Heavy Weight Has Been Placed on Their Chest
Diseases and Conditions Angina By Mayo Clinic Staff Angina is a term used for chest pain caused by reduced blood ﬂow to the heart muscle. Angina (an-JIE-nuh or AN-juh-nuh) is a symptom of coronary artery disease. Angina is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Angina, also called angina pectoris, can be a recurring problem or a sudden, acute health concern. Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort of indigestion. If you have unexplained chest pain, seek medical attention right away. Symptoms associated with angina include: Chest pain or discomfort Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness of breath Sweating Dizziness The chest pain and discomfort common with angina may be described as pressure, squeezing, fullness or pain in the center of your chest. Some people with angina symptoms describe angina as feeling like a vise is squeezing their chest or feeling like a heavy weight has been placed on their chest. For others, it may feel like indigestion. The severity, duration and type of angina can vary. It's important to recognize if you have new or changing chest discomfort. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack. Stable angina is the most common form of angina, and it typically occurs with exertion and goes away with rest. If chest discomfort is a new symptom for you, it's important to see your doctor to ﬁnd out what's causing your chest pain and to get proper treatment.
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Review of Systems – Clinician Documentation Aug 2019
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Heart Attack Symptoms
WARNING SIGNS and SYMPTOMS OF A HEART ATTACK Heart Disease is the most common cause of death in men and women and can often strike without warning. Despite advances in treatment for heart disease, only a fraction of patients make it to the hospital in time for them to benefit from these therapies. When treating heart disease, time is critical. Recognition of the symptoms of a heart attack is essential in obtaining potentially life-saving treatment. A heart attack can begin to damage the heart within 30 minutes of the start of symptoms and sometimes this damage may be irreversible. With heart attacks, TIME = MUSCLE. Call 911 as soon as symptoms appear! Many individuals do not realize they are having a heart attack because the symptoms may be mild, they may attribute the symptoms to stress, muscle strain, indigestion, or the flu. It is important to recognize these atypical symptoms because not all heart attacks manifest with chest pain. This tends to be the case more so in women compared to men. What are the symptoms of a heart attack? • Chest pain or discomfort: May feel like a squeezing, pressure, heaviness, tightness or fullness. • Heaviness or pain in other areas including back, neck, jaw or arms. This is more common in women. • The pain or pressure can be gradual or sudden. It may come and go, gradually intensify or awaken one from sleep. • Cold sweating: This can occur even without chest discomfort. If there is no obvious reason for sweating such as exercise or hot flashes, consider having your physician investigate this further.
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Types of Chest Pain Table
Types of Chest Pain This table explains some of the common causes, signs and symptoms of chest pain. Please remember that this information is a guide only. DO NOT USE FOR DIAGNOSIS. If symptoms persist, or you become unsure or concerned, please speak with your doctor. Name Cause of chest pain Symptoms of chest pain Location of pain How to relieve chest pain Angina Angina occurs when there isn't discomfort May be felt in the centre of Rest enough oxygen-rich blood flowing to tightness the chest or across the Anginine – dissolved part of your heart. Angina is caused pressure chest, into the throat or jaw, under the tongue by narrowed coronary arteries. squeezing down the arms, between the or heaviness shoulder blades Nitrolingual spray- dull ache Unstable angina may be sprayed under the unrelated to activity or Additional symptoms may include: tongue stress, comes on more nausea shortness of breath frequently or takes longer to strange feeling or ease tingling/numbness in the Angina symptoms can neck, back, arm, jaw or gradually get worse over 2 to 5 shoulders minutes. Angina usually lasts less light headedness than 15 minutes irregular heart beat Heart Attack A heart attack happens when plaque similar to angina however unable to pinpoint exact A heart attack is a cracks inside the narrowed coronary last longer than 15 minutes spot medical emergency. artery - causing a blood clot to form. and are not relieved by rest, May be felt in the centre of If the blood clot totally blocks the Anginine or Nitrolingual the chest or across the If pain is not relieved by artery, the heart muscle becomes spray chest, into the throat or jaw, Anginine or Nitrolingual damaged Additional symptoms may include: down the arms, between the spray in 10 to 15 minutes, nausea shoulder blades call 000 for an vomiting ambulance.
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Know the Warning Signs of a Heart Attack
Toolkit No. 22 Know the Warning Signs of a Heart Attack What is a heart attack? A heart attack happens when the blood vessels that go to your heart get blocked by fatty deposits or a blood clot. When this happens, the blood supply is reduced or cut off. Then oxygen and other materials can’t get through to your heart , hurting your heart muscle. Another name for a heart attack is myocardial infarction, or MI. If you have diabetes, you’re at risk for a heart attack. What are the warning signs of a heart attack? The warning signs include • chest pain or discomfort, tightness, pressure, or fullness. Call 9-1-1 right away if you have warning signs of This might feel like indigestion or heartburn. a heart attack. Getting help can help save your life. • discomfort in one or both of your arms, your back, jaw, neck, or stomach • shortness of breath • help blood flow in your heart • sweating • reduce chest pain • indigestion or nausea or vomiting These steps work best within an hour of the first warning • tiredness, fainting, or feeling light-headed signs of a heart attack. You may not have all of these signs, and they may come How are the signs of a heart attack and go. The most common warning sign for both men and women is chest pain. But women are more likely to different for people with diabetes? have some of the other warning signs. If you have chest Diabetes can affect your nerves and make heart attacks pain that doesn’t go away after you rest for a few painless or “silent.” A silent heart attack means that you minutes , you might be having a heart attack.
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AM 05 Hypotension Shock Protocol Final 2017 Editable.Pdf
Hypotension / Shock History Signs and Symptoms Differential • Blood loss - vaginal or • Restlessness, confusion • Ectopic pregnancy gastrointestinal bleeding, AAA, • Weakness, dizziness • Dysrhythmias ectopic • Weak, rapid pulse • Pulmonary embolus • Fluid loss - vomiting, diarrhea, fever • Pale, cool, clammy skin • Tension pneumothorax • Infection • Delayed capillary refill • Medication effect / overdose • Cardiac ischemia (MI, CHF) • Hypotension • Vasovagal • Medications • Coffee-ground emesis • Physiologic (pregnancy) • Allergic reaction • Tarry stools • Sepsis • Pregnancy • History of poor oral intake Blood Glucose Analysis Procedure B 12 Lead ECG Procedure A IV / IO Procedure P Cardiac Monitor Airway Protocol(s) if indicated Diabetic Protocol AM 2 if indicated History and Exam Suggest Type of Shock Adult Medical Protocol Section Protocol Adult Medical Cardiogenic Hypovolemic Distributive Obstructive Chest Pain: Cardiac and Allergy Protocol AM 1 Chest Decompression- STEMI if indicated P Needle Procedure if indicated Protocol AC 4 Suspected Sepsis Appropriate Cardiac Protocol UP 15 Protocol(s) if indicated if indicated Multiple Trauma Protocol TB 6 if indicated A P Notify Destination or Contact Medical Control Revised AM 5 02/18/2019 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS Hypotension / Shock Adult Medical Protocol Section Protocol Adult Medical Pearls • Recommended Exam: Mental Status, Skin, Heart, Lungs, Abdomen, Back, Extremities, Neuro • Hypotension can be defined as a systolic blood pressure of less than 90. This is not always reliable and should be interpreted in context and patients typical BP if known. Shock may be present with a normal blood pressure initially. • Shock often is present with normal vital signs and may develop insidiously.
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Review of Systems
Warren E. Hill, MD, FACS Neal A. Nirenberg, MD, FACS East Valley Ophthalmology, Ltd. Diplomate, American Board of Ophthalmology Diplomate, American Board of Ophthalmology 5620 E. Broadway Road Diplomate, American Board of Eye Surgery Cataract and Comprehensive Ophthalmology Mesa, Arizona 85206-1438 Cataract and Anterior Segment Surgery Telephone: (480) 981-6111 Facsimile: (480) 985-2426 Jonathan B. Kao, MD Yuri F. McKee, MD Internet www.doctor-hill.com Diplomate, American Board of Ophthalmology Diplomate, American Board of Ophthalmology Cataract, Cornea and External Disease Cataract, Cornea and Anterior Segment Surgery Glaucoma Surgery and Management Review of Systems For new patients, established patients who may be having new problems, or patients we have not seen in a while, we need to update your overall medical health. In each area, if you are not having any difficulties please circle No problems. If you are experiencing any of the symptoms listed, please circle the ones that apply, or you may write in ones that may not be listed. If you have any questions, please ask one of our staff. Cardiovascular Ears/Nose/Throat Musculoskeletal Respiratory Chest pain Dizziness Back pain Cough Irregular heartbeat Hearing loss Joint pain Trouble breathing Shortness of breath Hoarseness Muscle aches Wheezing ________________ Ringing in ears Stiffness ________________ Sore throat Swelling ________________ ________________ No problems No problems No problems No problems Constitutional Hematologic Neurologic Skin Fatigue Bleeding Balance problems
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