History

Presenting concern

Breast pain or lump history

HPI OPQRST

Onset

Provocation/Palliation

Quality

Region/Radiation

Severity

Timing

Lump characteristics

Lump features

Nipple and skin symptoms

Nipple symptoms

Skin symptoms

Infection and lactation context

Lactation context

Infection context

Prior episodes and baseline

Prior similar symptoms

Baseline breast changes

Exposures and trauma

Recent trauma

Devices and foreign material

Alarm Features

Immediate escalation triggers

Resuscitation triggers

Malignancy red flags

Cancer red flags

Infection red flags

Severe infection red flags

Implant complications red flags

Implant complication red flags

Medications

Current and recent meds

Medication review

Lactation related agents

Lactation influencing meds

Bleeding risk and immunosuppression

High risk classes

Allergy and analgesic options

Analgesic considerations

Diet

Exposures relevant to pain

Dietary pattern

Hydration and general intake

Recent intake changes

Review of Systems

Constitutional

System symptoms

Breast and regional

Local symptoms

Endocrine and reproductive

Hormonal context

Chest wall and cardiopulmonary mimics

Nonbreast causes

Collateral History and Family History

Family history

Breast and ovarian cancer history

Known hereditary syndromes

Collateral and social context

Support and reliability

Risk Factors

Malignancy risk

Breast cancer risk factors

Infection risk

Mastitis and abscess risk

Thrombosis and chest wall risk

Mimic risks

Differential Diagnosis

Life threatening

Life threatening causes

Common

Common causes

Less common

Less common causes

Past Medical History

Relevant conditions and procedures

Key PMH

Reproductive history

Physical Exam

General and vitals

Breast inspection

Inspection

Breast palpation

Palpation

Nipple discharge exam

Discharge findings

Lymph nodes

Nodes

Chest wall and mimics

Chest wall

Lab Studies

Pregnancy and infection workup

Targeted labs

Endocrine labs when discharge is milky

Galactorrhea labs

Imaging

Scoring Systems

Risk stratification and reporting

MRI

Breast MRI

CT

CT considerations

Ultrasound

Targeted breast ultrasound

Special Tests

Bedside and procedural diagnostics

Targeted tests

ECG

When chest pain mimic possible

ECG indications

Assessment

Problem based synthesis

Working diagnosis categories

Severity and risk

Severity and risk stratification

Plan

First 5 minutes if unstable or severe infection

Critical pathway

Diagnostic plan

Testing and sequencing

Treatment

Symptom control

Mastitis antibiotics

Abscess management

Lactation specific support

Breastfeeding guidance

Reassessment loop

Reassessment timing

Disposition

Discharge criteria

Outpatient pathway

Admission criteria

Inpatient criteria

Urgent referral criteria

Breast surgery or rapid diagnostic clinic

Discharge Instructions

Copy discharge instructions

Breast pain or lump summary

If treated for infection

Follow up timing

Return to ED now if

References

Guidelines and high quality sources

ACR Appropriateness Criteria for palpable breast masses and breast pain

NCCN Clinical Practice Guidelines in Oncology

ACOG Committee Opinion or Practice Bulletin

ABM Clinical Protocol

IDSA Skin and Soft Tissue Infection Guidelines