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Immediate risk stratification
High-risk presentation screen
Hemodynamic instability
SBP < 90 mmHg
Altered mental status
Airway threat
Stridor
Inability to handle secretions
Significant gastrointestinal bleeding
Hematemesis
Melena with syncope
Esophageal perforation concern
Severe chest pain after vomiting
Subcutaneous emphysema
Acute coronary syndrome not yet excluded
Chest pressure with exertion
Diaphoresis
Immediate actions if unstable
If shock, resuscitation bay and parallel workup
IV access and monitoring
ECG within 10 minutes for chest pain equivalent
If active hematemesis, massive GI bleed pathway
Blood product preparation
Early gastroenterology consultation
If perforation concern, broad-spectrum antibiotics and urgent CT chest with water-soluble contrast pathway
Surgical consultation
NPO status
Chest pain safety overlay
Noncardiac chest pain diagnosis only after appropriate cardiac evaluation
Serial high-sensitivity troponin per local protocol
Risk stratification tool per ED chest pain guideline
ACEP chest pain guidance alignment
Level A or Level B local pathway adherence for ECG and troponin in suspected ACS
Avoid anchoring on reflux with ongoing ischemic concern
Key concepts
Working diagnosis framework
GERD symptom syndromes
Typical reflux syndrome
Heartburn
Regurgitation
Extraesophageal reflux syndrome
Chronic cough
Laryngitis symptoms
Complication syndromes
Erosive esophagitis
Odynophagia
GI bleeding signs
Stricture
Progressive solid food dysphagia
Barrett esophagus risk phenotype
Long-standing frequent symptoms
Multiple risk factors
Diagnostic strategy principle
Empiric PPI trial appropriate for typical symptoms without alarm features
Symptom response supports GERD but does not fully exclude alternative diagnoses
Alarm features trigger early endoscopy rather than prolonged empiric therapy
Dysphagia
Unintentional weight loss
GI bleeding or anemia
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.