# Mild Sedation for Chest Pain?



## wanderingmedic (Nov 4, 2013)

I had this call a few days ago and wanted to get your thoughts. It was on one of my ALS rotations for medic school. 

A 32 yo M calls 911 for "crushing chest pain." We arrive on scene, and the pt is supine on his sofa with his hand clutched to his chest and is hyperventilating. He is visibly in discomfort. We do a full workup, and there is no ST segment elevation. The pt is in good health, not overweight, and does not report any illegal drug use. The pt is extremely anxious and very worked up, but has good vitals and is perfusing well. Pt reported tingling in his hands and face. We notice that every time we get him calmed down his chest pain decreases. We treat according to our chest pain of suspected ischemic origin protocol (O2, nitro, ASA, morphine, etc.), however I really think that this pt has some angina and the chest pain scared him.  He had lost his job and health insurance the week before. He also reported that he has had chest pain like this before, but it had never been "this bad." He had been referred to a cardiologist three years ago but never went. 

Here's my question: Because this guy was so worked up and the chest pain seemed to be connected to his anxiety, would it have been appropriate to give versed (or another drug to lightly sedate) - or call med control and ask for permission?

And please go easy...i'm a student trying to learn...it's why I'm asking.


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## chaz90 (Nov 4, 2013)

Sure, I'd consult with med control about treating his anxiety. I've called for low dose Versed orders on extremely anxious patients several times with great success.


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## Christopher (Nov 4, 2013)

chaz90 said:


> Sure, I'd consult with med control about treating his anxiety. I've called for low dose Versed orders on extremely anxious patients several times with great success.



I think I'd prefer lorazepam (Ativan) in this case, but yes when midazolam (Versed) is my only option I've used it for primary anxiolysis as well.


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## Carlos Danger (Nov 4, 2013)

azemtb255 said:


> Here's my question: Because this guy was so worked up and the chest pain seemed to be connected to his anxiety, would it have been appropriate to give versed (or another drug to lightly sedate) - or call med control and ask for permission?



It is always best to treat the underlying cause whenever possible.

So in this scenario, you just have to ask yourself: is the problem anxiety causing chest pain, or chest pain causing anxiety? Then you have your answer.

It sounds to me like an anxiety attack, in which case a benzo is the correct treatment. 

_(FWIW, versed would be my last choice for a scenario like this. If it's all you have it's OK, but it's anxiolytic effects don't last very long.)_


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