Recognising, assessing and managing chest pain

Chest pain is a common medical symptom that paramedics attend to in the out-of-hospital environment. The causes of chest pain and the signs and symptoms are explained in this article, alongside tools that could be useful in diagnosis, such as clinical risk scores and troponin testing. Finally, pain management strategies that use a balanced approach for optimal patient care are referred to, with some specificity for cardiac chest pain explained.

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Manejo da dor em punção venosa pediátrica: um pacote de medidas

Revista Recien - Revista Científica de Enfermagem ◽

10.24276/rrecien2021.11.33.157-168 ◽

2021 ◽

Vol 11 (33) ◽

pp. 157-168

Author(s):

Larissa Grispan e Silva Guimarães ◽

Natália Shinkai Binotto ◽

Stela Faccioli Ederli ◽

Mauren Teresa Grubisich Mendes Tacla

Keyword(s):

Pain Management ◽

Patient Care ◽

Nursing Staff ◽

Professional Growth ◽

Management Strategies ◽

Care Bundle ◽

Evidence Based ◽

Topical Anesthetic ◽

Care Research ◽

Before And After

Apresentar o processo de elaboração de um pacote de medidas para manejo da dor de crianças submetidas à punção venosa pela equipe de enfermagem. Pesquisa Convergente Assistencial, do tipo antes e após intervenção, realizada com a equipe de enfermagem de uma unidade pediátrica do sul do Brasil. Elaboração de pacote de medidas com seis estratégias selecionadas pela equipe de enfermagem a serem utilizadas antes e durante a punção venosa: preparo da criança e/ou acompanhante, posicionamento da criança, distração, amamentação, solução adocicada associada ou não à sucção não nutritiva e anestésico tópico. Os participantes manifestaram satisfação quanto ao modo de elaboração do mesmo, destacando a contribuição deste para seu crescimento profissional. O pacote de medidas otimizou a adoção das estratégias para manejo da dor. A Pesquisa Convergente Assistencial alicerçada na prática baseada em evidências mostrou-se adequada, visto que propiciou a aplicação de achados científicos no cenário assistencial considerando suas particularidades.Descritores: Manejo da Dor, Criança, Cateterismo Periférico, Enfermagem Baseada em Evidências. Management of pediatric venipuncture pain: a package of measuresAbstract: To present the process of elaboration of a patient care package for pain management in children undergoing venipuncture by the nursing staff. Convergent Care Research, before and after intervention, conducted with the nursing staff of a southern pediatric unit in Brazil. Patient care packege with six strategies, selected by the nursing staff, to be used before and during venipuncture: preparation of the child and/or companion, child positioning, distraction, breastfeeding, sweet-tasting solution with or without non-nutritive suction and topical anesthetic usage. The package of measures optimized the adoption of pain management strategies, highlighting its contribution to their professional growth. The patient care bundle optimized the adoption of strategies for pain management. The Convergent Care Research grounded in evidence-based practice showed appropriate, since it allowed the application of scientific findings in the care setting, considering its peculiarities.Descriptors: Pain Management, Child, Catheterization, Peripheral, Evidence-Based Nursing. Manejo del dolor de la venopunción pediátrica: un paquete de medidasResumen: Presentar el proceso de elaboración de un paquete de medidas para manejo del dolor de niños sometidos a la venopunción por el equipo de enfermería. Investigación Convergente Asistencial, del tipo antes y después de la intervención, realizada con el equipo de enfermería de una unidad pediátrica en el sur de Brasil. Paquete de medidas con seis estrategias seleccionadas por el equipo de enfermería que deben ser utilizadas antes y durante la venopunción: preparación del niño y/o acompañante, posicionamiento del niño, distracción, amamantamiento, solución dulce asociada o no a succión no nutritiva y anestésica tópica. Los participantes manifestaron satisfacción en cuanto al modo de elaboración del mismo, destacando la contribución de este para su crecimiento profesional. El paquete de medidas optimizó la adopción de estrategias para manejo del dolor. La Investigación Convergente Asistencial cimentada en la práctica basada en evidencias se mostró adecuada, visto que propició la aplicación de hallazgos científicos en el escenario asistencial considerando sus particularidades.Descriptores: Manejo del Dolor, Niño, Cateterismo Periférico, Enfermería Basada en la Evidencia.

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Implementation of a chest pain management service improves patient care and reduces costs

Heart Lung and Circulation ◽

10.1016/j.hlc.2009.05.639 ◽

2009 ◽

Vol 18 ◽

pp. S259

Author(s):

A.C. Scott ◽

K. O’Dwyer ◽

J. Gibson ◽

D. Dwyer ◽

A. Brown ◽

...

Keyword(s):

Chest Pain ◽

Pain Management ◽

Patient Care ◽

Management Service

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Implementation of a Chest Pain Management Service Improves Patient Care and Reduces Length of Stay

Critical Pathways in Cardiology ◽

10.1097/01.hpc.0000441082.64971.54 ◽

2014 ◽

Vol 13 (1) ◽

pp. 9-13 ◽

Cited By ~ 1

Author(s):

Adam C. Scott ◽

Kristina M. O’Dwyer ◽

Louise Cullen ◽

Anthony Brown ◽

Charles Denaro ◽

...

Keyword(s):

Chest Pain ◽

Pain Management ◽

Length Of Stay ◽

Patient Care ◽

Management Service

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Review of Prelabor Rupture of the Membranes: Pathophysiologic Concepts and Novel Therapeutic Strategies

Current Women s Health Reviews ◽

10.2174/1573404816999201026223954 ◽

2020 ◽

Vol 16 ◽

Author(s):

Saadia Ghafoor

Keyword(s):

Management Strategies ◽

Signs And Symptoms ◽

Cochrane Library ◽

Main Body ◽

Scientific Publications ◽

Timely Diagnosis ◽

Narrative Literature Review ◽

Contemporary Management ◽

Online Library ◽

Novel Therapeutic Strategies

Background:: Prelabor rupture of membrane (PROM) refers to the breakage of fetal membranes before the onset of labor, resulting in the leakage of amniotic fluid. PROM affects approximately 3% and 8% of preterm and term pregnancies. Because of associated high maternal and perinatal mortality, correct and timely diagnosis together with effective management is highly recommended to prevent adverse fetal and maternal outcomes. Objective:: To provide an overview of the novel concepts in the understanding of PROM including etiology, pathophysiology, risk factors, complications, assessment, diagnostic modalities, and contemporary management strategies for PROM at preterm and term. Methodology:: This narrative literature review was conducted through a literature search using the Cochrane library and electronic databases including PubMed, Web of Science, Medline, Scopus, Crossref, Google Scholar, Wiley online library, ScienceDirect with specific search terms in scientific publications published from March 1980 to March 2020. Main Body:: Preterm PROM has the potential to cause prenatal morbidity and mortality. It is imperative to monitor the signs and symptoms of an impending infection due to the risk of infectious morbidity with PROM at preterm and preterm. PROM at preterm and term requires prompt diagnosis followed by an appropriate management strategy. Conclusion:: The correct and timely diagnosis of PROM is essential for efficacious management. Furthermore, it can reduce avoidable emergent health care visits and related costs in a clinical setting subjected to pregnancy with suspected PROM. Further studies are needed to fill the gaps in identifying better diagnostic predictive tools in high- risk pregnancies.

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Commentary on Chaplain-Physician Interactions From the Chaplain’s Perspective: A Mixed Method Analysis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211003080 ◽

2021 ◽

pp. 104990912110030

Author(s):

Rev George Handzo ◽

Rev Brian Hughes

Keyword(s):

Best Practices ◽

Health System ◽

Patient Care ◽

Health Systems ◽

Mixed Method ◽

Effective Strategies ◽

Optimal Patient Care ◽

Relationship Of ◽

The Relationship ◽

Method Analysis

Gomez and her colleagues have presented a helpful study of the relationship of the chaplains in her health system to physicians which highlights several barriers to a well-integrated relationship and thus to more optimal patient care. We have seen these same barriers as we have consulted with health systems nationally and have also identified many best practices that mediate or even eliminate many of these barriers. This commentary describes some of what we have seen as chaplain-generated causes of those barriers and effective strategies that have been employed to overcome them. We also provide some resources for chaplains who wish to institute some of these best practices themselves.

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International survey: real-world pain management strategies

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1183 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Hagen ◽

A Georgescu

Keyword(s):

Pain Management ◽

Real World ◽

Pain Control ◽

Online Survey ◽

Management Strategies ◽

Pain Medication ◽

International Survey ◽

Nationally Representative ◽

Online Panels ◽

Control Pain

Abstract Background Pain is a nearly universal experience, but little is known about how people treat pain. This international survey assessed real-world pain management strategies. Methods From 13-31 January, 2020, an online survey funded by GSK Consumer Healthcare was conducted in local languages in Australia, Brazil, Canada, China, Colombia, France, Germany, India, Italy, Japan, Saudi Arabia, Malaysia, Mexico, Poland, Russia, Spain, Sweden, UK, and USA. Adults were recruited from online panels of people who agreed to participate in surveys. Quotas ensured nationally representative online populations based on age, gender, and region. Results Of 19,000 people (1000/country) who completed the survey, 18,602 (98%) had ever experienced physical pain; 76% said they would like to control their pain better. Presented with 17 pain-management strategies and asked to select the ones they use in the order of use, respondents chose an average of 4 strategies each. The most commonly selected strategies were pain medication (65%), rest/sleep (54%), consult a doctor (31%), physical therapy (31%), and nonpharmacologic action (eg, heat/cold application; 29%). Of those who use pain medication, 56% take some other action first. Only 36% of those who treat pain do so immediately; 56% first wait to see if it will resolve spontaneously. Top reasons for waiting include a desire to avoid medication (37%); willingness to tolerate less severe pain (33%); concerns about side effects (21%) or dependency (21%); and wanting to avoid a doctor's visit unless pain is severe or persistent (21%). Nearly half (42%) of those who take action to control pain have visited ≥1 healthcare professional (doctor 31%; pharmacist 18%; other 17%) about pain. Conclusions This large global survey shows that people employ a range of strategies to manage pain but still wish for better pain control. Although pain medication is the most commonly used strategy, many people postpone or avoid its use. Key messages More than three-quarters (76%) of respondents across countries seek better pain control. Pain medication and rest/sleep consultation are the most common pain management strategies. More than half of respondents (56%) wait to see if pain will resolve spontaneously before taking any action, and 56% of those who use pain medication try some other approach first.

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An absolute risk-guided approach to cardiovascular risk management within a chest pain clinic: the ARCPAC randomized trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2916 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

J.A Black ◽

J Campbell ◽

J Sharman ◽

M Nelson ◽

S Parker ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cardiovascular Risk ◽

Chest Pain ◽

Smoking Status ◽

Absolute Risk ◽

Pain Clinic ◽

Risk Scores ◽

Cardiovascular Risk Management ◽

Risk Factor Management

Abstract Background The majority of patients attending chest pain clinics are found not to have a cardiac cause of their symptoms, but have a high burden of cardiovascular risk factors that may be opportunistically addressed. Absolute risk calculators are recommended to guide risk factor management, although it is uncertain to what extent these calculations may assist with patient engagement in risk factor modification. Purpose We sought to determine the usefulness of a proactive, absolute risk-based approach, to guide opportunistic cardiovascular risk factor management within a chest pain clinic. Methods This was a prospective, open-label, blinded-endpoint study in 192 enhanced risk (estimated 5-year risk ≥8%, based on Australian Absolute Risk Calculator) patients presenting to a tertiary hospital chest pain clinic. Patients were randomized to best practice usual care, or intervention with development of a proactive cardiovascular risk management strategy framed around a discussion of the individual's absolute risk. Patients found to have a cardiac cause of symptoms were excluded as they constitute a secondary prevention population. Primary outcome was 5-year absolute cardiovascular risk score at minimum 12 months follow up. Secondary outcomes were individual modifiable risk factors (lipid profile, blood pressure, smoking status). Results 192 people entered the study; 100 in the intervention arm and 92 in usual care. There was no statistical difference between the two groups' baseline sociodemographic and clinical variables. The intervention group showed greater reduction in 5-year absolute risk scores (difference −2.77; p<0.001), and more favourable individual risk factors, although only smoking status and LDL cholesterol reached statistical significance (table). Conclusion An absolute risk-guided proactive risk factor management strategy employed opportunistically in a chest pain clinic significantly improves 5-year cardiovascular risk scores. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Tasmanian Community Fund

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