I skimmed the comments and many had merit, but I liked this one best
I have no idea, I've never heard that.
A Physician makes a medical diagnosis,
A Nurse makes a nursing diagnosis,
A Paramedic makes a provisional diagnosis,
A Mechanic makes a mechanical diagnosis ...
Each of those is a diagnosis but they may be different than each other depending upon the type of diagnosis being made; certainly a medical and nursing diagnosis differ but the Paramedics provisional diagnosis and the Physicians medical diagnosis may be the same or differ too depending on what is found but they are both for all intents and purposes a diagnosis.
And every one except the top one is based on a protocol rooted in the top one. ANy valid protocol below MD which starts with the name of a diagnosis instead of a sign or anatomic area (e.g., "MI", instead of "Chest Pain" or "Chest" or "Thorax") is also invalid as it presupposes the practitioner has already made a medical diagnosis.
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Back on track:
OP: any question which relates one s/s as THE certain indicator of a condition, especially for protocol-driven practitioners, is invalid.
Think of it as Venn diagrams (intersecting circles? Remember?). Each sign and symptom is a circle (list of s/s), and where most of them intersect indicates the likely diagnosis, or the applicable protocol/action. Remember it is not certain, and pts often have more than one problem, plus historians can influence histories.
OK, you're a day's hike from help at an expensive rental and your significant other c/o chest pain. You can instantly drop everything and carry them to help, or consider the following:
1. VS including rate, regularity and quality of apical and palpated pulses and respirations; plus chest auscultation.
2. Palpate costochondral areas firmly but not hard to elicit tenderness, malformation or crepitus; ditto thoracic spine . If you don't know what costochondral area is, skip it, and tend towards transport.
3. Observe for bruising, lumps, foreign objects, asymmetries, shifts.
4. Observe for SOB, pallor or cyanosis, air hunger, guarding.
5. Observe for level of energy and affect (tired/discouraged/scared?).
6. Ask about hx of indigestion, belching, similar earlier episodes, any earlier dx. If so, do these episodes get better with eating, antacids, sitting up? Worse with swallowing? Worse or better with position of neck/head, arms? Worse with a deep breath?
7. ASK what the pain felt like: zipping, tearing, electric shock, sudden or slow onset, sudden or slow recession, or is it ongoing?
And some others. NO mention of a pulse ox, labs, ekg.
These presume you have the knowledge base (didactic and practical), the confidence to use your senses, and are not in a situation where you are bound by protocol to act in a certain manner.
And you could STILL have your loved one keel over and die in your arms.
Tenderness of the chest does not rule-out MI. Tenderness reproducing the exact sensation plus normal s/s and VS means it makes the picture look more optimistic. Follow your protocols and learn.:angry:
EDIT: Well, I thought of one; absence of breathing for over three minutes is presuptive for respiratory failure. The differential gets sticky, but safety, airway and BVM is indicated STAT.
