Hi, this is Steve Carroll and you're listening to EM Basic. Today we're going to talk about one of the most common yet possibly serious complaints that we face every day, chest pain. This complaint is a myriad of possible causes for it, and we are the front line of medicine as far as diagnosing all these possible serious causes. Just about anyone who shows up to any outpatient office with the chest pain will get referred our way for further workup, so we need to be good at this.

First off, I am obligated to say that this podcast doesn't represent the views or opinions of the Department of Defense, the U.S. Army, or my residency program.

With that out of the way, let's start with one of the most broad and vexing topics in emergency medicine, chest pain. So first off, you're going to pick up the chart, read the triage note, make sure to look

at their vital signs and look at the EKG.

So for the vast majority of patients, the EKG will already be on the chart.

So you want to ask yourself one question real quick.

First of all, is this a STEMI?

So you want to start looking at their anatomical locations. You want to look at, I like to

look at them in certain groups. Let's look at 1 in AVL, 2, 3, and AVF, V1, 3, V3, and V4 to V6, and make sure not

to neglect AVR. So let's go over this one more time. So one in AVL is your lateral leads. Two and three,

AVF is your inferior leads. V1 to V3 is your anterior septal leads. And V4 to V6 is your lateral

leads. So then you want to do some sort of systematic approach. So I use this Dubin's method,

which is look at their rate, rhythm, axis intervals,

and look for signs of ischemia. I'm not going to go over all these things, but, you know,

the big things are, you know, what's their rate, are they in science or them or not science rhythm,

they have major axis deviation, and make sure to address all their important intervals.

Their PR, their QRS, their QT intervals are the most important ones.

Next, you want to look for any flip T waves.

These can be signs of aschemia.

You want to look for any elevations that you may see.

These can be signs of infarction,

whereas any depressions in your ST segment can be aschemia

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