UDK  616.1/.2-083.98                          

ISSN 2466-2992 (Online) (2021) br. 2, p. 8-22

COBISS.SR-ID 58305545

MANAGEMENT OF CHEST PAIN IN PREHOSPITAL SETTINGS

Saša Ignjatijević1, Dušica Janković2, Aleksandra Mihajlov2, Milan Elenkov3

1 University Clinical Centre Niš, Emergency Centre, 2 EMS Institute, Niš,

3 General Hospital Pirot

Summary:

INTRODUCTION: Acute chest pain is a sudden onset of pain in the form of tightness, pressure in the frontal part of the chest wall, limited between middle axillary lines left and right and the suprasternal fossa above and the xyphoid process below. Anamnestic data on the reasons why the patient comes depends on the age, sex, associated diseases, alcohol or drug use. The above-mentioned factors and cultural differences lead to different experiences of the character and intensity of pain and different interpretations of the health problem. Limited diagnostic tools in prehospital settings are the reason for the impossibility of making an early diagnosis and the reason for the large percentage of visits to emergency departments of hospitals.

SOURCE AND SELECTION OF AVAILABLE MATERIAL: Review of available professional literature using the terms: chest pain syndrome, prehospital, management, chest pain.

SYNTHESIS OF MATERIALS: In prehospital settings, focused gathering of anamnestic data, detailed clinical examination and use of diagnostic tools are the basis for assessing the causes of chest pain. Patients at-risk include: hemodynamically unstable patients, patients with previous cardiovascular events as well as the ones with risk factors for the development of atherosclerotic changes. To make a working diagnosis in a patient with chest pain, a targeted anamnesis is taken, clinical examination and ECG are performed. After the ECG, it is necessary to assess the patient's condition. Information about the pain is collected by the acronym OPQRST for easier memory. The findings obtained by a clinical examination are usually not specific in order to confirm or reject its existence, although in some cases it can be highly specific. Based on available diagnostic tools, focused history and clinical examination in prehospital settings, possible diagnoses of life-threatening chest pain could be the following conditions: Acute coronary syndrome with constant ST elevation, Acute coronary syndrome with transient ST elevation, Pulmonary thromboembolism, Aortic dissection, Acute pericarditis and pericardial tamponade, Pneumothorax and Esophageal rupture. Initial prehospital therapy of chest pain includes managing pain, administration of drugs to control blood pressure, control of hemodynamics, as well as adequate anti aggregation, antithrombotic and fibrinolytic therapy.

CONCLUSION: Making an accurate diagnosis in patients with chest pain in prehospital settings is difficult due to a number of factors. The time constraints required to take detailed data on symptoms and previous conditions make it difficult to make a diagnosis, and the lack of diagnostic and laboratory equipment also makes it difficult to assess the patient in prehospital settings. The preliminary diagnosis is made on the basis of targeted anamnesis, clinical examination and ECG. Therefore, a large number of patients must be referred for further diagnostic examinations.

Key words: Prehospital, management, chest pain.

Korespondencija/Correspondence

 

Saša IGNJATIJEVIĆ

University Clinical Centre Niš,

Emergency Centre

E mail: siscrat@gmail.com

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