Serial killers: Acute chest pain

Targeting the most common chief complaints and deadly diagnoses to consider in prehospital medicine

In EMS education, we often start with a diagnosis and teach from there – for example, congestive heart failure, asthma and COPD are all podcast topics we have previously tackled. But, how to get to the final diagnosis is often a process that all levels of emergency providers struggle with. To go from a chaotic chest pain scene with unstable vitals, then filter to a differential of 1. pulmonary embolus, 2. acute coronary syndrome, 3. thoracic aortic dissection is often quite challenging.

The MCHD Paramedic Podcast “Serial Killer Series” is going to target the most common chief complaints and the killer diagnoses that you should always consider. We’re not going to spend time with non-emergent/chronic diagnoses, just the ones that are deadly when missed. That’s where we, as emergency providers, must begin.

Here, MCHD Medical Directors Dr. Robert Dickson and Dr. Casey Patrick kick things off with acute chest pain. We’ll cover shortness of breath, abdominal pain and altered mental status in future episodes.

MCHD Paramedic Podcast · Episode 79 - Serial Killer Series - Chest Pain

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Medic Mindset Podcast: Thinking about chest pain

Host Ginger Locke interviews Dr. Brandon Bleess about patients with a chief complaint of chest pain

This article was originally posted June 11, 2020. It has been updated.

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About the author

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.