04: Acute Coronary Syndrome: Case 1 Hamish
The GP assesses Hamish
- S(ite): Q. Where is your chest pain Hamish?
A: In the centre of my chest.
- O(nset): Q. When did the chest pain start?
A: It started this morning in the house and was there when I was walking to the surgery.
- C(haracter): Q. What does the chest pain feel like?
A: It feels like a tightness across my chest.
- R(adiation): Q. Does the pain go anywhere else?
A: It can go down my left arm but not every time.
- A(ssociated Factors): Q. Do you feel anything else besides the chest pain?
A: I feel sick and sweaty at times.
- T(ime): Q. How long does the pain last, Hamish and does it ever come on at rest?
A: It usually goes away when I stop walking, about 10-15 mins and yes it has done in the last couple of days.
- E(xacerbating): Q. Is there anything that makes the pain worse or better?
A: If I take an indigestion tablet, it may ease the pain but not always.
- S(everity): Q. How bad is your pain Hamish, with 1 being little or no pain and 10 being the worst pain you’ve ever felt?
A: It's about 7 this morning but can be less depending on what I am doing.
Dr Donald reviews the ECG that Iona performed and gives Hamish 300mgs of Aspirin to chew and 2 puffs of GTN spray sublingually. The pain resolves within 2 minutes. (Patients presenting with acute chest pain need to be assessed urgently and have a diagnostic Electrocardiogram (ECG) performed as quickly as possible to determine the correct treatment.)
Rapid assessment and accurate diagnosis lead to prompt treatment and better outcomes
For further information on the clinical assessment of your patient for ACS see.