Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.

18Jul/110

Chest Pain Master Class

  • Cocaine Chest Pain - patients with cocaine chest pain typically do well. Patients with positive urine cocaine tests are NOT stressed at our institution. They can be safely ruled out with serial troponins.
  • Erlanger protocol doesn't just mean 2 EKGs, 2 sets of enzymes, 2 hours 'n go.  They require a true reevaluation prior to discharge, EKG comparison and followup the next day - and must be low-risk.
  • In the ED evaluation of the chest pain patient, classic risk factors like DM, HTN, and tobacco use are "nuisance" variables and do not affect your pretest probability. Clinician gestalt is overwhelmingly correct.
  • A Coronary Calcium CT score of zero is good for approximately 1 year (and possibly longer in those aged 35-45).
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