Post operative chest pain

Metro Medical Direct

Post Operative Chest Pain: Eliciting the underlying cause

Raymond Zakhari, NPwww.MetroMedicalDirect.com


Most Common Etiologies

Cardiac Pulmonary Gastric Musculo-skeletal


History: Key questions to ask Where is the pain or pressure located?

Point with one finger Use the same words back to the patient when

assessing, reassessing, and documenting It is very important to clearly elicit what

the patient means by the word pain Sharp Dull Aching Burning


Detailed history: Quality Quantify the pain

or pressure 1-10 scale? What is it at it’s

worst? What is it at it’s

best? Is it tolerable?

Repeat this after each intervention

Have you ever had this pain or pressure before? Tell me about that

time What was done

about it? Is there anything

different about this incident from the last time?


Detailed History: Character Is the pain constant or

intermittent? How long between episodes of

pain? How long does each episode

last? Is each episode getting

progressively better or worse?

How long have you been experiencing this episode of pain?

Are there any other associated symptoms with this?

Nausea Vomiting Dizziness Numbness/ tingling Sweating Itching Sense of impending doom Anxiety Bad or sour taste in your mouth Does the pain radiate?

Jaw Neck Teeth Shoulder Nose Eyes


Detailed History: Aggravating & Alleviating Factors

Does anything make the pain better or worse? Movement

Reaching Walking Position changes

Touching the site of pain Breathing


Physical Exam: Vital Signs Apical Heart Rate compared to Radial Pulse

for 1 minute Check peripheral pulses compare to baseline quality

Respiratory Rate including depth and pattern Blood pressure compared to baseline Oxygen Saturation (hand should be covered,

and heart rate should correlate) Oral Temperature Finger Stick Blood glucose


Physical Exam: Neuro & Psych

Is the person Awake, Alert & oriented to person, time, place and purpose?

Are they speaking in normal voice? Rate of speech? Organized thought progression? Appropriate answers to simple

questions? Able to follow commands?


Physical Exam: Cardiac & Pulmonary Lung Sounds and Effort

Clear and unlabored vs. crackles with accessory muscle use?

Does the patient assume a certain posture to help with breathing?

How many balls can they raise on the incentive spirometer compared to previous?

Are the neck veins distended? Are all pulses symmetrical and palpable


Physical Exam: Abdomen/ Extremities Is there Abdominal Distension?

Hyperactive bowel sounds Is there any swelling, heat or

discoloration of an extremity? Is this bilateral or unilateral? Is it a change from baseline? Is there an obvious external cause?

Immobility Tourniquet, ID bracelet, BP cuff, compression

device, ice pack, heat pack


Clinical Characteristics: Cardiac etiology Pain is often called

pressure +/- Radiating (Vagus

Nerve Innervation post cardiac transplant patients usually do not radiate)

+/- nausea or vomiting +/- Lightheadedness +/- Numbness/ tingling +/- Sweating Last longer than 5 minutes Episodes should be

triggered by exertion Constant while at rest

Not made better or worse by palpation or reaching


Clinical Characteristics: Pulmonary Embolus

Chest pain worse with deep breathing Low or downward trending SpO2 Tachycardia or heart rate trending

upward (minus other causes) Patient becoming restless or agitated Risk factors present (history of clots,

long travel, normally on anticoagulant)


Clinical Characteristics: Gastric related chest pain/ pressure Pain is changed (usually improved)

by positioning, palpation, movement Abdominal distension Associated bloating Eructating and passing flatus Acidic taste or sour taste in mouth Associated heart burn or history of

reflux


Clinical characteristics: Musculoskeletal Chest Pain Pain is made worse with movement Pressing on a certain point makes

pain worse Patient is guarded in their

movement Topical agents relieve the pain (heat

rub, ice pack etc.) No other associated symptoms and

or history of recent/ remote trauma


When in doubt: Take a History and Physical Check a complete set of Vital Signs

HR, BP, RR, T, SpO2, Finger stick (low blood sugar can cause anxiety and somatization and altered mental status)

Do a 12 Lead ECG Page the NP, Primary Team If no response or decompensating call

Rapid Response (44444)

Post operative chest pain

Education

Transcript of Post operative chest pain