Page 208 - ATP-P 11th Ed

Other Etiologies of Chest Pain
1. The following signs and symptoms MAY suggest a GI etiology such as gastroesopha-
geal reflux disease (GERD): dyspepsia, dysphagia, burning quality to chest pain, ex-
acerbated by lying flat, foul or brackish taste in mouth. A trial of antacids or ranitidine
®
(Zantac ) 150mg PO bid may be useful if evacuation will be delayed.
2. Severe chest pain following forceful vomiting may indicate esophageal rupture.
Administer IV normal saline 150mL/hr and ertapenem (Invanz ) 1g IV and evacuate as
®
Urgent.
SECTION 2 3. bolus or spontaneous pneumothorax. Auscultate the lungs. Unilaterally diminished
Sudden onset of pleuritic chest pain with dyspnea may indicate pulmonary em-
breath sounds suggest pneumothorax which may require decompression. Administer
oxygen, establish IV access, administer aspirin (ASA) 325mg PO for suspected PE, and
evacuate as Urgent.
4. The following signs and symptoms MAY suggest a musculoskeletal etiology: pain
isolated to a specific muscle or costochondral joint pain exacerbated with certain types
of movements, noncentral chest pain reproduced upon palpation. A trial of NSAIDs
®
such as ibuprofen (Motrin ) 800mg PO tid may be useful if evacuation will be delayed.
5. Chest pain with gradual onset and exacerbated by deep inspiration and accompanied by
fever and productive cough MAY indicate lower respiratory tract infection. Consider
treatment per Bronchitis/Pneumonia Protocol.

Disposition
1. Urgent evacuation
2. Evacuation platform should include ACLS certified medical personnel and the
equipment, supplies, and medications necessary for ACLS care.
3. Do not delay evacuation if unsure of chest pain etiology. Strongly consider early
contact with a medical officer or medical treatment facility for consultation. Fre-
quently reassess the patient suspected of a non cardiac etiology to ensure stability
and accuracy of the diagnosis.

198 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 199