TY - JOUR T1 - The ABC of community emergency care JF - Emergency Medicine Journal JO - Emerg Med J SP - 226 LP - 232 DO - 10.1136/emj.2003.013938 VL - 21 IS - 2 AU - C Laird AU - P Driscoll AU - J Wardrope Y1 - 2004/03/01 UR - http://emj.bmj.com/content/21/2/226.abstract N2 - Chest pain is the commonest reason for 999 calls and accounts for 2.5% of out of hours calls. Of patients taken to hospital about 10% will have an acute myocardial infarction (AMI). Evidence suggests that up to 7.5% of these will be missed on first presentation. There are a number of other life threatening conditions, which can present as chest pain and must not be overlooked. The objectives of this article are therefore to provide a safe and comprehensive system of dealing with this presenting complaint (box 1). Box 1 Objectives of assessment of patients with chest pain To undertake a primary survey of the patient and treat any immediately life threatening problems To identify any patients who have a normal primary survey but have an obvious need for hospital admission To undertake a secondary survey considering other systems of the body where dysfunction could present as chest pain To consider a list of differential diagnoses Discuss treatment based on the probable diagnosis(es) and whether home management or hospital admission is appropriate Consider follow up if not admitted ABC principles Primary survey—If any of the following present treat immediately and transfer to hospital Airway obstruction Respiratory rate <10 or >29 per minute O2 sats <93% Pulse <50 or >120 Systolic BP <90 mm Hg Glasgow coma score <12 There are four life threatening medical conditions that can present with chest pain. These are: Acute coronary syndrome (ACS) Massive pulmonary embolus Dissection of the thoracic aorta Tension pneumothorax The history and a brief examination may lead you to suspect that one of these is the probable diagnosis but often in the early stages, patients may not have significant abnormal physical signs. Nevertheless, urgent hospital admission must be arranged if you suspect any of the above or any other life threatening … ER -