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.
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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

Adam Thomas

CRACKCast Co-founder and newly minted FRCPC emergency physician from the University of British Columbia. Currently spending his days between a fellowship in critical care and making sure his toddler survives past age 5.
Chris Lipp is one of the founding Fathers for CrackCast. He currently divides his time as an EM Physician in Calgary (SHC/FMC) and in Sports Medicine (Innovative Sport Medicine Calgary). His interests are in paediatrics, endurance sports, exercise as medicine, and wilderness medical education. When he isn’t outdoors with his family, he's brewing a coffee or dreaming up an adventure…..