Chest pain assessment

Emergency First Aid Training - Chest Pain

As a good first aider I am sure that you are conversant with using a few mnemonics to help you remember first aid procedures. Sometimes it is difficult to remember all the steps involved in helping someone, so this method of memory retention can be a huge help. I frequently use mnemonics in ambulance world and as we are all used to refreshing our skills regularly in pre-hospital care, I am going to go through a process to show that there is an easy way to assess a patient with pains in the chest.

Patient assessment and history taking are extremely important in pre-hospital care.

Let’s paint a picture, it is 11:15am and you are in an office at work, Jerry a 60 year old male colleague comes to you looking pale and sweaty and complaining of feeling sick. At this point he could have pretty much anything, a multitude of issues so where do we start?

Well, getting the patient to sit down would be a start but we are really looking at how to question this patient efficiently to get an indication of what’s going on. Now we can go on about ambulance stuff but this is really for first aid. First aiders don’t have access to the diagnostic tools that paramedics do so questioning becomes really important.

Just a simple question of “Jerry, you look awful, what’s happening?” would be a start that anyone would ask. From this simple question may come a tide of responses possibly advising that he has some pain in the chest or in a similar region.

Just a simple question of “Jerry, you look awful, what’s happening?” would be a start that anyone would ask. From this simple question may come a tide of responses possibly advising that he has some pain in the chest or in a similar region.

So now we know he has pain in the chest, what else do we want to know?

In early years in NSW ambulance we used a mnemonic being the PQRST of pain. In Victoria we tend to use DOLOR ( I still prefer PQRST). Many reading this will know what that is, but I’ll go through the steps.

P for provoking factors

Question: Jerry, what were you doing when the pain came on?

It is important to know what the patient was doing at the time they experienced pain. Was Jerry walking, running, sitting, engaged in a stressful activity. Did the pain come on from a muscular activity like lifting or carrying something? Remember we are trying to ascertain the cause of the pain all the while assuming that it is cardiac in origin until ruled out.

Q for Quality

Question: Jerry what does the pain feel like?

This question will give an indication that the pain is heavy, sharp, burning, tight, squeezing, dull etc.

R for region and radiation

Question: Jerry where is the pain? Followed by does the pain go anywhere?

We need to know the origin of the pain and if it goes anywhere.

Let’s assume now that Jerry has indicated that the pain he is experiencing is heavy, starting in the centre of his chest and moving into his left jaw and arm. I’m sure by now you are getting a picture of what is possibly cardiac chest pain. What else do we need to know?

S for severity

Question: Jerry how bad is the pain? Give me a score from 0 to 10, with 0 being no pain and 10 being the worst pain you could imagine.

Pain is always subjective so you may think this has little use. My 8/10 pain may be your 2/10 pain because I have less tolerance so why is this of use at all? It will give an indication of their discomfort sure but it will also help to develop a trend over time. Once we start to give any treatment we will want to know if it is effective or not and to see if Jerry is deteriorating so while the pain scale may be a bit hit and miss, it will help show a trend.

T for time of onset

Question: What time did this happen Jerry?

Jerry may say that he has had the pain for days but it just got worse or it came on suddenly but we need to know when it started.

What have we got so far?

Jerry is a 60 yr old male that was sitting at his desk at 11am when he started to experience 6/10 heavy, central chest pain radiating to his left jaw and arm. This sounds cardiac in origin to me.

What else would we do besides calling the ambulance. Perhaps Jerry has medications that he normally takes, so we could ask about that. Perhaps ask Jerry to take a deep breath. It may sound odd considering we are pretty sure the pain is cardiac in origin, but the question has 2 uses. 1. Can Jerry actually take a deep breath or is he short of breath and 2. It he takes a deep breath and the pain is suddenly sharp and he can point to its origin with one finger perhaps we are looking at possibly a more respiratory cause. It’s just a rule of thumb and really as a first aider we only have to go so far but these sort of easy questions divide the good first aiders from the rest.

So there you have it, PQRST of pain is a great acronym to help remember some of the basics when it comes to assessment of someone with pain in the chest. There are other things that we can do too but we’ll leave that for another time.