Dispo for COPD/Asthma/CHF exascerbations that include chest pain

[Meza]

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When you have a regular Asthma/COPD/CHF exascerbation that includes chest pain, when do you rule them out? Based on age, risk factors, acuity, or just rule em' all out?

How many have resources like Chest pain units and in-house stress to rule them out in the ER?

 

[ERMudPhud]

When you have a regular Asthma/COPD/CHF exascerbation that includes chest pain, when do you rule them out? Based on age, risk factors, acuity, or just rule em' all out?

How many have resources like Chest pain units and in-house stress to rule them out in the ER?

CHF with chest pain I think I would probably rule out. Asthma with chest pain I don't see so often and unless they gave a good story with good risk factors I probably wouldn't pursue it. Most of the asthmatic I see are awfully young to have coronary disease. COPD with chest pain is also something I don't see very often. Most asthmatics and COPD'ers that I see don't have chest pain. If the COPD'er told me they always got chest pain with their exacerbations and the story didn't sound very ischemic and they had had a previous cardiac workup I might not pursue it. It probably would depend heavily on the individual history. We don't have an in ED chest pain unit because with our patient population (generally middle class and insured) it didn't make sense financially or logistically to keep patients for hours in the ED getting a rule out and stress test. Other hospitals in town do have in ED chest pain units though.

 

[Sessamoid]

CHF with chest pain I think I would probably rule out. Asthma with chest pain I don't see so often and unless they gave a good story with good risk factors I probably wouldn't pursue it. Most of the asthmatic I see are awfully young to have coronary disease. COPD with chest pain is also something I don't see very often. Most asthmatics and COPD'ers that I see don't have chest pain. If the COPD'er told me they always got chest pain with their exacerbations and the story didn't sound very ischemic and they had had a previous cardiac workup I might not pursue it. It probably would depend heavily on the individual history. We don't have an in ED chest pain unit because with our patient population (generally middle class and insured) it didn't make sense financially or logistically to keep patients for hours in the ED getting a rule out and stress test. Other hospitals in town do have in ED chest pain units though.

That's pretty much my approach too.