Low risk chest pain

ERCAST.ORG

Which chest pain patients can be discharged?

ERCAST.ORG - February 20, 2016 BY Rob Orman

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"Ryan Radecki from EM Lit of Note is here to deconstruct the HEART score, utility of stress tests in low risk patients, and his approach to low risk chest pain. As a bonus, Ryan is also the wordsmith for the show notes.

The Show notes…

There is no such thing as “zero-risk” chest pain...

Once you learn to stop worrying and love again, where are we going with “low-risk” chest pain?

Simply put, most of our observation chest pain evaluations represent low-value care...

• Sensitivity for nSTEMI is about 90% at ED presentation.
• Specificity of any troponin elevation, however, is 50-60%.
• The longer the time from onset of symptoms, the more reliable the sensitivity.
• Repeating a troponin 1- or 2-hours after presentation, particularly for those presenting early in symptoms, will increase sensitivity for late rise – and likewise improve specificity by ruling out AMI for patients’ whose troponins do not increase.

Step 2: Shared decision-making