As a practicing clinician it is your worst nightmare; failing to properly diagnose a patient with Acute Coronary Syndrome.  Here at CME4Life, we try to keep you from getting caught in disastrous situations. We like to DRIVE home different ideas to help you from getting burned that have come from years of experience in working in an ER.

We talked about COLDER FAST, which may have been helpful to some starting clinicians to help remember what to ask when diagnosing the history of a patient with chest pain. Today were are going to help DRIVE home another good lesson for diagnosing acute coronary syndrome.

If any of these 4 symptoms present in a patient that comes in complaining of chest pain, you better be ready to act, because they are going to die if not taken care of properly, and soon! Once again we want to DRIVE this idea into your head so if you see one of these symptoms you will know that you need to act, immediately.

D – Diaphoresis – If a patient exhibits sweating, beaded sweat, as though it looks like they just got done running a few miles, be aware, this is a bad sign. I would be willing to say any patient that ever presents Diaphoresis, be very cautious, something is seriously wrong.

R – Radiation – Radiation of pain. If a patient has pain that is bi-lateral, again, not a good sign. If the pain goes to the left, bad news, to the right, bad news. If the pain goes down their body, it may not be cardiac, but do not rule out vascular.

I – I won’t get burned! – Again, we want to DRIVE home the idea that you will not get burned by any patient that shows signs of chest pain.

V – Vomiting – Chest Pain + Vomiting = SINISTER!!

E- Exertion – This is probably the easiest, but one that we cannot forget. If someone presents with chest pain while doing any physical activity, shoveling the driveway, mowing the lawn, lifting anything heavy; and begins to feel better when laying down and resting, classic sign of ACS.

Remember, here at CME4Life we try to DRIVE home pearls and mnemonics to keep you from getting burned. If any patient shows any of these signs when complaining of chest pain DO NOT SEND THEM HOME, regardless of what an EKG or other test says.