PAIN

PAIN

Pain is an unpleasant feeling often caused by intense or damaging stimuli

Pain is an unpleasant sensory and emotional experience

associated with actual or potential tissue damage, or described in terms of such damage

CHEST PAIN

CHEST PAIN EVALUATION

O – X Format

O : OVERALL ( PRIMARY) SURVEY ABCs-- CAB Age Vital signs Oxygen therapy Cardiac monitoring History of previous heart conditions Diabetes Hypertension Stroke Medications

P: POSITION P: PROVOCATIONPosition Left chest Right Chest Sub sternal Epi gastric Mid back Generalized Provocation

ColdHeat

Stress

Q : QUALITY

Pressure/squeezing Discomfort

Burning Sharp

Aching

R: RADIATION Left/right arm

Neck, Jaw Anywhere at all

S: SIGNS & SYMPTOMS Nausea vomiting

Diaphoresis Anxiety

Shortness of breath Dizziness

T: TIMING – DURATION

When did the pain begin? When did the pain end? Does it come and go?

U: UNCOMFORTABLE FEELING Pain scale 0-10 (0 - NO pain to 10

worst pain or discomfort)

Signs of non cardiac pain

V: Variation Variation with deep inspiration Pain increased or changed with position

W: Worse With palpation

X: eXisting Pain lasts a few fleeting seconds

CHEST PAIN IN CHILDREN Costochondritis : painful inflammation of

the cartilage that attaches the ribs to the sternum Common cause of chest pain in kids and teen.

Girls more – sharp stabbing pain ( like Heart Attack) It goes off in 2- 3 days – or last bit

longer Cause ?? …. related to injury .. physical

strain – heavy lift – exercise --- repeated coughing

Pain go worse when child take deep breathing – coughing ..

Other Assessments….

Why does pain during a heart attack tend to radiate toward the left side of the body

Many organs in the body have very few specific pain receptors (nociceptors).

the heart has very few or no nociceptors, the brain has a difficult time interpreting irritation as pain.

The nerves from your heart join with other organs from the general area and follows the same nerve pathways to your spinal cord then to your brain.

This creates a sensation of generalized discomfort commonly interpreted as pressure or a dull ache to the generalized area, typically the left arm and neck

Assessments……………… Putting together ……………

What we will do ??????

Initial Assessment: CAB ……….ABC Determine whether the pain may be

cardiac --- the other origin Consider -----HistoryPresence of CV risk factorsH/O IHD – Previous treatmentsPrevious investigations – for chest pain

Determine the cause of Chest Pain

Brief targeted History – physical assessment

Admitted before – pneumonia, GB, COPD,

U. Angina,-- DM Describe chest pain --- character– scale –PQRST Initiate appropriate intervention

Vital signs: Baseline ----------• B Cardia----- poor function of heart • Tachy Cardia – Inadequate perfusion

• ^BP – result of pain -- • ^workload of heart /myocardial O2 requirement

Head to toe assessment : use senses –

--- Look ---Listen ---- Feel—

Neurological assessment ( brief) ..ask personal questions , Squeeze your hand, Press feet against hard surface ( all can be done while checking VS/monitoring

Heart …monitoring --- Rhythm– rate – Auscultation--- Lungs –Resp effort – dyspnea, /tachypneaBreath sounds– clear– crackly– wheezingPain on inspiration --- O2 sat--- >94% Abdomen– distended, Bowel movement, nauzea, vomiting. Pain begin -…

after eating(GERD) relieved by eating

If no definite diagnosis – treat as of cardiac origin Investigations – Medications