Effectiveness of Advanced Chest Pain Protocol Audrey Bolt Stephanie Brock Tri-County Technical

To determine if the patient’s chest pain is related to cardiac ischemia, you would look for ST-segment depression and/or T wave inversion. If the ST-segment depression is at least 1mm (one small box) below the isoelectric line, it is significant and occurs in response to inadequate supply of blood and oxygen, which leads to an electrical disturbance. Once this is treated, adequate blood flow is restored, the ECG changes will resolve, and the ECG will return back to patient’s baseline.

Prior to starting medical treatment, I would like to obtain an ECG first to make sure that your chest pain is not related to any heart disease. GERD is most likely the cause of noncardiac chest pain, but it is important for patient safety that we get an ECG to make sure that we don’t overlook the possibility that you are having any cardiac symptoms (Buttaro et al., 2017).

It is applicable to obtain arterial blood gases (ABG) or pulse oximetry for patient experiencing a severe exacerbation (Booker, 2014). Chest X-ray and ECG

The important arguments for the need to implement evidence-based practice (EBP) are that it leads to the highest quality of care and the best patient outcome (Melnyk & Fineout-Overholt, 2011). It is the standard of practice for nurses to be able to use research skills for evidence-based knowledge that are relevant to their clinical practice. The purpose of this paper is to outline and compare the selected articles on how the study findings related to patients with chest pain, to determine the validity and reliability of the selected articles, and to formulate a plan for implementing the newly acquired knowledge into clinical practice.

Cook County was having more patients than it could handle complaining about chest pain. Also, determining if the pain could be a heart attack was a very inefficient and a long process with too much information. So they streamlined the process, mainly considering 4 things which were the EGG, fluid in lungs, systolic pressure, and unstable angina. The results were more accurate and saved time. This showed that, sometimes with too much information, there is too much of the complicaticated information and an answer can’t be reached and with less information a correct answer can be reached quickly.

Early recognition of signs and symptoms and taking the right steps to identify, distinguish, and manage subtypes (STEMI and NSTEMI/UA) will improve Mr James outcomes (Bradley E.H., 2006)Recognizing the signs and symptoms such as chest pain or shortness of breath suggestive of an MI and obtaining an ECG as soon as possible (goal of less than 10 minutes following presentation of a patient) should be the standard of practice to manage this patient It has been demonstrated that reperfusion of the infarct-related artery in the very first hour (golden hour) of MI reduces mortality rates (Ayrik et al. 2006, Van de Werf et al. 2008). fact, every 30 minutes of delay time, the 1-year mortality risk increases by (DeLuca et al. 2004).According to triage and first assessment guidelines (Wrightet. al. 2011) Patients who complain of chest pain , pressure , tightness or heaviness require immediate assessment by the triage nurse and should be referred for further evaluation.

Patients experiencing chest pain require immediate assessment, including a twelve lead ECG within the time frame of ten minutes, will provide vital evidence of a cardiac, plueretic or musculoskeletal event (Acute Coronary Care Clinical care standards 2014).

Recent updated NICE guidance recommends 12-lead electrocardiography as soon as possible in patient with acute chest pain but warns not to exclude ACS if the ECG is normal (Cooper, Timmis, Skinner, 2010).

Serious causes for chest pain include: Acute Coronary Syndromes (ACS): New onset angina, accelerating or crescendo angina and prolonged angina or coronary insufficiency, non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). The typical features of cardiac chest pain are 1.) located under the breastbone or at least some of the pain is situated in this area, 2.) other features include provocation by exercise or stress and 3.) relief by rest or nitroglycerin. If all three features are present the patient is

The decision either to perform or not to perform a cardiac catheterization in a patient who also has acute renal failure can be a difficult decision to reach. Diagnostic blood and urine tests can prove to be beneficial in helping the provider make such a tough decision. The contrast used in the cardiac catheterization can harm the function of the kidneys, and it can push the patient from acute to chronic renal failure, which can influence quality of life as well as morbidity and mortality. When a patient has chest pain, the nurse practitioner should perform a thorough assessment to ensure the angina is cardiac-related and not from another source, such as pleuritic chest pain or muscular chest pain (Grossman & Porth, 2014). Once it is confirmed by one’s assessment that the chest pain is cardiac-related, then one should look at serum diagnostic results, such as the cardiac enzymes.

The purpose of this paper is to discuss a new best practice, the necessary steps for implementing the new practice, and support this change in practice with current literature. Heart disease is the leading cause of death in the United States. Evidence-based clinical practice guidelines regarding patients with ST-segment elevation myocardial infarction (STEMI) seek to reduce variation in practice and improve outcomes for this patient population (O 'Gara et al., 2013). Current evidence-based practice includes immediate reperfusion therapy to the involved coronary artery in this patient population. However, it is often challenging for emergency department nurses to implement the initial steps of this evidence-based practice, which includes obtaining a 12-lead electrocardiogram within ten minutes of arrival, as some patients present with symptoms other than chest pain, or atypical symptoms. For instance, atypical presentations include shortness of breath, altered mental status, upper extremity pain, upper back pain, generalized weakness, and abdominal pain (Glickman et al., 2012). Ultimately, this results in delays of reperfusion therapy.

Providing care for post percutaneous coronary intervention (PCI) patients has evolved and the guidelines and protocols have been heavily influenced by research and evidence based practice (EBP). Unfortunately, coronary heart disease has become a major issue for the health status of Americans across the lifespan. According to the CDC, “About 610,000 people die of heart disease in the United States (U.S.) every year – that’s 1 in every 4 deaths.” In addition, treating coronary heart disease patients has negatively impacted the economic status of U.S. healthcare. Therefore, to manage

Chest pain is a common presenting symptom among nearly 10% of school-age children seeking health care services. Studies have shown that at least 80% of pediatric patients seeking medical evaluation for chest pain are not cardiac related, hence, the diagnosis of non-cardiac chest pain (NCCP). On the other hand, if cardiac cause is a possibility, a prompt referral to a cardiologist is extremely important. (Lee, J. L., Gilleland, J., Campbell, R. M., Johnson, G. L., Simpson, P., Dooley, K. J., & Blount, R. L. 2013). A complete health history detailing

The characteristics of pain from myocardial infarction and pericarditis can help to differ both the conditions, and rule out the actual problem of the patient. The characteristics of myocardial infarction include pain duration- 30 minutes to 1 hour; pain intensity and type- severe, crushing, occurs on exertion; and pain does not relieve by the rest or taking nitroglycerine. However, pericarditis, the inflammation of pericardium causes pain that lasts for hours to days; pain intensity and type- mild to severe, asymptomatic, sharp or cutting; pain increases with breathing, swallowing, belching, neck or trunk movement; and relieved by leaning forward, kneeling, sitting upright, or breath holding (Goodman & Snyder, 2013). Therefore, the therapist should ask the patient questions about his or her pain duration, type, intensity, aggravating factors, and relieving factors to rule out whether it is MI or an acute onset of

One of the top-rated exam for chronic chest pain-CAD, is SPEC MPI rest & stress. This test is a Myocardial perfusion test also known as a nuclear stress test. It uses physical activity like running and rest, to measure how the blood flow is to the heart. Radioactive tracers are used and given through the blood and images are taken with a gamma camera. This test is non-invasive and can tell if the arteries are blocked and how many are