I had a conversation with a few of the residents about the management of low risk chest pain in the Emergency Department. The issues which always seem to come up are:
- If the first troponin is normal, can I send them home?
- I don’t think this is cardiac, let’s just get one troponin and then send ’em home.
- Okay fine, let’s just do two sets and then send ’em home.
The patients which are obviously cardiac and obviously not cardiac are easy, but what about those ones in which there’s some question?
There’s a great review in Circulation from 2010 which discusses the management of low risk patients (click the link to get the article) and it’s not all about cardiac risk factors.
If you’re not into reading, then here are two short videos I made summarizing it. Let me know what you think and then we’ll discuss it in the context of our patients during a shift.
Note: I’ve switched from uploading the video files which stream from the site (very slowly) to embedded YouTube videos (which stream much more quickly). This has the downside of breaking the podcast version. I don’t think anyone will mind because I’m pretty sure no one has downloaded it yet.
patwari 