Approach to the Critical Patient

Immediate priorities

Stabilization and safety

Rapid exclusion of time critical mimics

Working diagnosis confirmation

Key concepts

Core clinical pattern

Tietze syndrome distinction

History

Symptom characterization

Pain phenotype

Time course and precipitating factors

Onset pattern

Duration

Risk stratification for dangerous causes

Cardiac risk context

Thromboembolism risk context

Aortic risk context

Infection and inflammation context

Physical Exam

Chest wall and musculoskeletal exam

Costochondral exam

Adjacent structures

Cardiopulmonary exam

Vital signs

Cardiac exam

Respiratory exam

PITFALLS

Missed serious disease

Infection and trauma misses

Differential Diagnosis

Life threatening and must not miss

Critical chest pain diagnoses

Common mimics and related entities

Musculoskeletal

Dermatologic and neurologic

Gastroesophageal

Inflammatory and infectious

Laboratory Tests

Cardiac and systemic screening

Risk based labs

Targeted labs by alternate diagnosis

PITFALLS

Troponin interpretation limitations

D dimer limitations

Diagnostic Tests

Scoring Systems

Risk tools for chest pain and PE

MRI

Role limited in typical costochondritis

CT

Imaging usually unnecessary for classic costochondritis

Ultrasound

Point of care applications

Disposition

Level of care decisions

Discharge appropriate after exclusion of serious causes

Observation or admission triggers

Follow up planning

Treatment

Analgesia and anti inflammatory strategy

First line supportive care

Oral analgesics

Refractory pain options

Avoidances

Treatment evidence notes

Evidence overview

Special Populations

Pregnancy

Pregnancy specific considerations

Geriatric

Higher risk alternate diagnoses

Medication cautions

Disposition cautions

Pediatrics

Pediatric chest pain context

Red flags

Treatment

Background

Epidemiology

Frequency in chest pain presentations

Typical age patterns

Risk associations

Pathophysiology

Mechanism

Tietze syndrome mechanism

Therapeutic Considerations

Rationale for supportive care

NSAID rationale

Topical agents rationale

Physical therapy rationale

Low risk chest pain strategy rationale

Patient Discharge Instructions

copy discharge instructions

Diagnosis explanation

Expected course

Home care

Return to ED now

Follow up

References

Clinical guidelines and evidence sources

Evidence sources

Project source file

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.