CRACKCast E026 – Chest Pain

In CRACKCast, Podcast by Adam Thomas1 Comment

This episode of CRACKCast covers Rosen’s Chapter 26, Chest Pain. This chapter covers a broad approach to chest pain with emphasis on the 6 critical diagnoses you cannot miss in the ED.

Shownotes – PDF Here

Rosen’s in Perspective

Symptom caused by numerous diseases

  • Afferent visceral fibers from the heart, lungs, great vessels, esophagus enter the same thoracic dorsal ganglia. This results in the same indistinct quality and location of pain. This is typically described as:
    • Burning
    • Aching
    • Stabbing
    • Pressure
  • Because these nerve segments overlap three segments above and below an individual level, the pain can be produced from the jaw to epigastrium with radiation.

1) List 6 critical causes of chest pain


1) Walk through a systems approach to chest pain including common and uncommon causes of chest pain

Some system causes to think about in addition to the BIG SIX

  • CARDIO (cocaine induced-angina/vasospasm)
  • GI (Mallory-Weiss; cholecystitis; pancreatitis)
  • MSK (muscle strain; rib fracture; costochondritis; chest wall pain)
  • NEURO (spinal root compression; thoracic outlet syndrome; herpes zoster; post-herpetic neuralgia)
  • OTHER (psychological; hyperventilation)

2) Outline your approach to the person with sudden onset severe chest pain

  • Approach it similarly to acute onset dyspnea:
    • Simultaneously EVALUATE, IDENTIFY, and INTERVENE
    • MOVIE
      • Monitors
      • Oxygen
      • Vitals
      • IV
      • Equipment and environment
    • Labs
    • ECG
    • Portable CXR
    • Full history and physical
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Adam Thomas

Adam Thomas

Adam Thomas is a MedEd re-purpose-r. He cofounded the CrackCast project to fill the obvious gap in current FOAMed. He is a true podcasting supporter, and finds it to be the best way he learns. Currently a resident in the FRCP program at the University of British Columbia.
Adam Thomas
- 2 days ago
Chris Lipp
Chris Lipp is one of the founding Fathers for CrackCast and an EM Resident in Victoria, BC. His interests are in sports, exercise, and wilderness medicine. When he isn’t out on one of his accidental 20km trail runs, you can find him jamming with friends, or outdoors, and reading Rosen’s…..