subject: The 5 Lethal Causes Of Chest Pain: The Emergency Department Assessment [print this page] If you miss this causes of chest pain, your patient could die. Chest pain is that risky.
"Who's Your PAPPA" is a system to assist you in the evaluation of any patient with chest pain. Whether it is chest pain, pressure, shortness of breath, indigestion or cough, you have to ask, "Who's Your PAPPA?". You need to look at them, point to them and say, Whos your PAPPA?The mnemonic PAPPA is designed for the high risk causes of chest pain that may cause a lethal outcome. So, these are the high-risk, cant-miss causes of chest pain.
If we play the odds, we are obligated to focus our attention toward the acute coronary syndrome. Even if it's not an acute coronary syndrome, it may still be lethal diagnosis. Trust me when I say that you do not want to come to work and have someone say to you, Hey, remember that patient you saw the other daybecause these conversations never end positively, its not that they sent you a thank you note. More commonly it is that the patient was admitted to another hospital with something bad, or came back with something bad, or died!
I developed the mnemonic "PAPPA" to identify the main causes of chest pain. The first two, PA or PAPPA have to do with the heart. The next two, PP, have to do with the lungs. And the last A is an aneurysm.
P is Pericarditis A is as Acute coronary syndrome (or acute myocardial infarction) P is Pneumothorax P is Pulmonary embolism A is Aneurysm.
When evaluating a patient with chest pain, there are two key points: you need a system of patient evaluation as well as a system of objective evaluation: the EKG/ECG and cardiac enzymes.
You have to be a master at 12 lead EKG/EKG interpretation. Are you able to recall the causes of os ST segment that may mimic an acute myocardial infarction? This is the most critical, important point of this article: chest pain is a risky business. You need a system, to apply 100% of the time in any patient that presents with chest symptoms. It has to simple and easy to recall. Ask, Whos Your PAPPA. This works, I swear by it. Then, you have to be strong at evaluating the 12 lead EKG/ECG. There are no larger law suits then a missed myocardial infarction. 25% of missed myocardial infarctions are due to miss read EKG/ECGs. Sharpen you EKG/ECG skills!
