Cannot miss / life threats
Cannot miss / life threats
Differential diagnosis — checklist
0/19
Check off each diagnosis as you consider it. Tap the name for unique exam, lab/imaging clues, first-line confirmatory test, and management.
Cardiac0/5
Pulmonary0/5
GI0/5
MSK / other0/4
Initial ED workup
Bedside0/4
- ECG within 10 min
- Continuous cardiac monitor
- IV access x2
- SpO₂, BP both arms
Labs0/4
- Troponin (serial)
- BMP, CBC, coags
- Lactate if unwell
- Type & screen if dissection/PE suspected
Imaging0/3
- CXR
- Bedside US (effusion, RV strain, B-lines)
- CTA chest if PE/dissection suspected
Initial management0/4
- ASA 324 mg chewed if ACS suspected (no contraindication)
- Nitro SL if ischemic pain & SBP > 100, no RV infarct, no PDE-5
- Heparin per ACS / PE protocol
- Pain control: fentanyl preferred over morphine — fentanyl has minimal histamine release (less hypotension), faster onset (1–2 min) and shorter duration, no active metabolites in renal failure, and is hemodynamically safer in ACS, dissection, and shock
Pearls / pitfalls
Pearls
- Tearing pain radiating to back + BP differential → dissection until proven otherwise
- Pleuritic + tachycardia + hypoxia → PE (use PERC/Wells)
- Diabetics, elderly, women may present atypically