# Normal appearing Chest pain



## Chris EMT J (Apr 9, 2022)

Hi had this patient that was a young adult with chest pain. I did a quick BSI assessment, then saw 1 patient, asked for HPI and Pmx which was pain started 10 minutes ago no other symptoms and no past medical history, SAMPLE: CP, no allergies, no meds, no pmx, last oral intake was a healthy breakfast 6 hours, no events leading to. OPQRST: onset, non prevoked, described as sharp, non radiating, 10/10 severe but not constant pain, started 15minutes ago. 
After history I was pretty re-ensured. Did a exam which was normal breathing and heart sounded fine. Did a ECG and I saw a normal rate and saw it was sinus. The medic saw a completely normal ECG and vitals were all normal. We established a line and I gave aspirin. BP was normal but soft so didn't give nitro. I have the ECG for you guys and gals to look at and give your opinion but also had a question of wether you would still have given nitro with a BP of 108/59? Protocol says give nitro if BP is not low but instinct said no because BP may become really low.  Paramedic said nitro may not help this type of pain anyway and that he wouldn't risk hypotension but what do you think? Yes or no to aspirin?


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## Chris EMT J (Apr 9, 2022)

Sorry about the coffee stain lol


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## Chris EMT J (Apr 9, 2022)

Also we do have the suspension that this is muscle/Skeleton related because there was ribs that were tinder especially in the conjunction connecting them to the sternum, also a pain that comes and goes, and is described as sharp, but still could be other things I assume.


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## CCCSD (Apr 9, 2022)

Ruptered Supra lateral Etna with Bilateral Otitis Media.


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## Tigger (Apr 9, 2022)

We don’t use nitro for ACS at all anymore. There is not great evidence for its use. Not to mention if you aren’t suspecting ACS what would indication would you have for nitro?

There are many reasons for chest pain, not all require a cardiac treatment pathway.


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## Chris EMT J (Apr 9, 2022)

Tigger said:


> We don’t use nitro for ACS at all anymore. There is not great evidence for its use. Not to mention if you aren’t suspecting ACS what would indication would you have for nitro?
> 
> There are many reasons for chest pain, not all require a cardiac treatment pathway.


Yeah our chest pain protocol still say nitro but neither me, my EMT basic partner, or the paramedic thought this would need nitro. So we didn't give nitro.


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## NomadicMedic (Apr 10, 2022)

ChrisEMTA said:


> Also we do have the suspension that this is muscle/Skeleton related because there was ribs that were tinder especially in the conjunction connecting them to the sternum, also a pain that comes and goes, and is described as sharp, but still could be other things I assume.


When assessing, did you swipe left or right on the ribs?


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## Chris EMT J (Apr 10, 2022)

NomadicMedic said:


> When assessing, did you swipe left or right on the ribs?


Yeah.


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