The Overrun

The Overrun


Episode 107: Cardiac and Non-Cardiac Chest Pain with Dr. Mike Berkenbush

February 26, 2024

Summary



Dr. Mike Berkenbush joins the podcast to discuss the challenges in EMS education on differentiating chest pain. The conversation highlights the need for a broader approach to chest pain, beyond just focusing on heart attacks. The importance of field impressions and open-ended questions in assessment is emphasized. The discussion also explores the physiological differences in chest pain presentation and the potential mimics of chest pain, such as pericarditis and aortic dissection. The role of honesty and patient education, as well as the potential value of point-of-care troponin testing and AI in EKG interpretation, are also discussed.



Takeaways



EMS education should focus on a broader approach to chest pain, beyond just heart attacks.



Field impressions and open-ended questions are crucial in assessing chest pain.



Physiological differences and potential mimics of chest pain should be considered.



Honesty and patient education are important in managing patient expectations.



Point-of-care troponin testing and AI in EKG interpretation have potential value in pre-hospital care.



Chapters



00:00 Introduction and Background



00:42 The Problem with EMS Education on Chest Pain



03:03 Recognition of Pre-Hospital Care in Cardiac Cases



04:01 Focus on Time-Sensitive Interventions



05:00 The Need for a Broader Approach to Chest Pain



06:07 The Challenge of Teaching Differential Diagnosis



07:03 Guiding EMTs in Assessing Chest Pain



08:13 The Importance of Field Impression



09:00 The Dangers of Casting a Wide Net



10:16 Physiological Differences in Chest Pain Presentation



11:19 Mimics of Chest Pain: Pericarditis and Aortic Dissection



12:25 Other Mimics: Cholecystitis and Pneumonia



13:00 Differentiating Chest Pain from Other Conditions



14:14 The Importance of Describing Types of Pain



16:11 The Role of Open-Ended Questions in Assessment



18:07 The Challenge of Teaching Assessment Skills



19:06 The Impact of EMS Communication on Patient Expectations



20:28 The Importance of Honesty and Patient Education



22:43 The Potential Value of Point-of-Care Troponin Testing



25:28 The Role of AI in EKG Interpretation



26:49 The Potential for BLS Providers to Perform 12-Lead EKGs



27:11 Conclusion



https://www.sciencedirect.com/science/article/pii/S2773232023000081



https://www.sciencedirect.com/science/article/pii/S0735675721000279



Then, Ed and Dan discuss the challenges and considerations surrounding the assessment and treatment of chest pain by BLS providers. They explore the tendency to over-triage chest pain cases and the need for a more nuanced approach. They emphasize the importance of field provider information in guiding patient care and highlight the role of EMS in the overall healthcare system. The conversation also touches on the need for ongoing learning and skills development, as well as the value of knowing the receiving facility. The episode concludes with final thoughts on the topic.



Takeaways



  • Avoid over-triaging chest pain cases and consider a more nuanced approach to differential diagnoses.

  • Field provider information is crucial in guiding patient care and can make a difference in the patient’s trajectory through the emergency department.

  • EMS providers should recognize their role in the healthcare system and the importance of their assessments and findings.

  • Continued learning and skills development are essential for providing better care to patients.

  • Knowing the receiving facility and building relationships with the staff can improve patient outcomes.

  • Balancing the fear of litigation with effective assessment is important, and acting in the best interest of the patient is key.

  • BLS providers are expected to know more and do more in the evolving healthcare landscape.

  • Choosing the right center for patients based on their needs and available resources is crucial.

  • A thorough assessment, understanding the patient’s story, and considering associated symptoms are essential in evaluating chest pain cases.