PERCENTAGE OF PT WITH CHEST PAIN. 15% I.M.A. 30-35% Unstable Angina 55%: Non coronaropathy. PERCENTAGE OF MISSING IMA. In patient with atypical symptoms (4-13%).
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Volume 1, Issue 3, May 2000Chest Pain
Author Karcz A; Holbrook J; Burke MC; Doyle MJ; Erdos MS; Friedman M; Green ED; Iseke RJ; Josephson GW; Williams K Institution Department of Emergency Medicine, Metrowest Medical Center, Framingham, Massachusetts. Title Massachusetts emergency medicine closed malpractice claims: 1988-1990. Source Ann Emerg Med 1993 Mar;22(3): p553-9
CONCLUSION: Emergency physicians must have a particular awareness of their great risk exposure for missed myocardial infarction. Addition of dictation or voice-activated record generation systems, departmental protocols for radiograph follow-ups, and holding and re-evaluation of the intoxicated patient will help provide systems supports for reducing the liability of individual emergency physicians.
Author Murata GH Institution Ambulatory Care Service, Veterans Affairs Medical Center, Albuquerque, NM 87108. Title Evaluating chest pain in the emergency department. Source West J Med 1993 Jul;159(1): p61-8
Chest pain is one of the most difficult diagnostic problems for physicians working in an emergency department. In this setting, more malpractice dollars are awarded for missed myocardial infarction than for any other physician error. This problem usually occurs when the patient has atypical symptoms, the physician is inexperienced, or the diagnosis is not considered.. .. feature of a patient's history excludes infarction with certainty, pain that is sharp, positional, pleuritic, or reproduced by palpation indicates a lower probability of acute ischemic heart disease. established the prognostic value of the initial electrocardiogram.. Emergency physicians must also consider other diseases for which coronary care might be beneficial.
*Alcune fibre del ganglio cerv superiore si connettono col ganglio del trigemino
** A questo livello giungono le informazioni somatiche dei dermatomeri contigui
1)ATTACK PROGRAM: is that patients crashing with an acute myocardial infarction need to be quickly identified and given prompt opening therapy be it thrombolytic or PTCA
2) OBSERVATIONAL PROGRAM. Once acute myocardial infarction has been ruled out, this unit attempts to determine which patients with chest pain are more likely to have myocardial ischemia (moderate probability) and which are unlikely to have myocardial ischemia (low probability).
3) OUTREACH PROGRAM by, "providing for the success of a low probability ischemic pathway work up in which 80% of such patients can be sent home...." This third component of the Chest Pain Center focuses on prevention and community education
Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort study
K R Herren, research fellowa, K Mackway-Jones, consultanta, C R Richards, research assistanta, C J Seneviratne, consultant clinical scientistb, M W France, consultantb, L Cotter, consultantc.
a Department of Emergency Medicine, Manchester Royal Infirmary, Manchester M13 9WL, b Department of Clinical Biochemistry, Manchester Royal Infirmary, c Manchester Heart Centre, Manchester Royal Infirmary
Correspondence to: K Mackway-Jones email@example.com
Dear Dr RinciariThank you for your email. It will be possible for you to come and observe without any special documentation. A letter from your institution introducing you will suffice.YoursKevin Mackway-JonesEmergency DepartmentManchester Royal InfirmaryOxford Road MANCHESTER M13 9WLT +44(0)1612766781F +44(0)1612768538
Initiated in 1993 as a joint program of the divisions of Emergency Medicine and Cardiovascular Medicine.
Close cooperation between the two Division has been an essential feature of the CPEU which is administered by the Division of Emergency Medicine with close consultation by the Division of Cardiovascular Medicine
The CPEU is staffed by 3 physicians who have completed residency in internal medicine with further training in exercise stress testing
The CPEU is covered daily by one of these Ph.
Consultation is available to these physicians at all times by the CCU attending cardiologist in selected cases as needed.
During the night (8p.m - 8a.m.),
these patients are managed by the Cardiology Inpatient Service (CIS), which can admit them to the CPEU for further evaluation and disposition
Patients presenting to the ED) who are identified as low risk by clinical criteria (< 7 % MI, < 15% unstable angina) for an ischemic event and its complications are triaged to the CPEU. If low risk is confirmed (clinically stable and resting ECG being normal or having only minor nonspecific repolarization abnormalities) and other serious causes of chest pain are absent on screening evaluation, the patient usually undergoes immediate exercise treadmill testing (IETT)
Hamot's Chest Pain Center-based in the Emergency Department-is the point of entry for patients experiencing chest pain. There, emergency physicians immediately begin the process of evaluating and diagnosing the cause of the chest pain. From the initial evaluation in the Emergency Department, physicians work to determine if the patient has most likely already suffered a heart attack, is in danger of suffering a heart attack, or if the chest pain is not cardiac related. From that initial evaluation, the most appropriate next steps are determined.
The protocol monitors moderate- to low-risk patients over an 18- to 24-hour period
“It’s so important to make a diagnosis of coronary disease sooner, rather than later,” says Dr. Ted Szymanski, chair of Emergency Medicine, Mayo Clinic/St. Luke’s Hospital. “Now we are able to assess coronary risk by stratifying patients in the Emergency Department, which allows for quicker diagnosis and in many cases, keeps us from admitting patients who don’t need to be.”
More than 44,000 people seek Harrison's emergency care each year, making it one of the most visited ERs in Washington
Harrison's chest-pain clinic (also known as at the rule-out MI, for myocardial infarction, clinic), sees 300 people a year. A decade ago, these patients might have spent one week in the hospital before being diagnosed
Billie Dunford, RN, Harrison's Critical Care Director, says the advantages of the chest-pain clinic aren't limited to quick assessment and patient convenience.
University of Michigan Health System
16-bed unit in the University Hospital's Emergency Department serves adult and pediatric patients who need additional follow-up after seeing U-M emergency physicians for chest pains, abdominal pain, dehydration, asthma attacks, and other conditions.
Chest Pain Unit is adjacent to the existing Emergency Department and features five cardiac observation beds. Patients experiencing chest pain or other symptoms of a heart attack should enter the main EMERGENCY DEPARTMENT
After evaluation and testing in the Emergency Department, most patients complaining of chest pains can be treated in the Chest Pain Center
For many, the center is able to answer the question about the pain's cause in less than a day without being admitted to the hospital
The Paul Dudley White Coronary Care SystemSt. Agnes Health Care, Baltimore, Maryland
components necessary for a Chest Pain Center in the Emergency Department