Leading the EMS World in Pediatric Education
Wednesday August 23rd 2017

Pediatric Chest Pain: Not Your Father’s Chest Pain – Episode 11

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Kids having chest pain? Really?! Should we be breaking out the aspirin, nitroglycerin, and 12-leads? Well that depends upon what the cause of that chest pain is.

As a great compliment to our syncope episode, pediatric chest pain is an infrequent complaint that may be the result of any number of things from trauma, to infection, to cardiac-related causes.  Join Russell Stine, Arnold Facklam, and Kyle David Bates as they talk to Dr. Lou Romig about this perplexing complaint that kids may actually present with.

**I  apologize about the audio quality. We had some issues with the microphones and technology but found it still to be a fascinating episode!

Pediatric Chest Pain outline

The Listener will be able to:

  1. Identify and discuss the various etiologies of pediatric chest pain.
  2. Obtain and interpret pertinent history of a pediatric patient having chest pain.
  3. Perform and interpret an assessment of a pediatric patient having chest pain.
  4. Discuss appropriate treatment of a pediatric patient having chest pain.

References
A pediatric chest pain slide presentation

Chest Pain in Children and Adolescents

From Dr. Lou:

Here’s a brand new article (Management of Pediatric Chest Pain Using a Standardized Assessment and Management Plan, Pediatrics, Vol 128, No 2, Aug 2011) that looked at 406 children from 7-21 yrs of age presenting during 2009 for  outpatient evaluation for pediatric chest pain at Children’s Hospital Boston. Of the 406 pts, only 5 had a cardiac etiology – 2 had pericarditis, 2 had SVT and 1 had nonsustained episodes of V-tach (? etiology). The pericarditis patients had abnormal EKGs and classic complaints and physical findings. All arrhythmia patients complained of palpitations as well as chest pain. 8 patients were found to have previously undiagnosed incidental cardiac diagnoses not related to the chest pain (1 WPW pt and 7 structural cardiac abnormalities). 99% of the patients referred for cardiology evaluation for chest pain were determined to have noncardiac sources for their pain. Keep in mind that this is 99% of the children referred to a specialist for their chest pain. There are undoubtedly many more who were not referred. This reinforces two of the main points in our chest pain session: 1) the overwhelming majority of kids with chest pain are not having an acute cardiac event and 2) the small number of patients that are having a cardiac event have positive histories, physical exams and/or EKG

There’s also a concise review article on causes of pediatric sudden cardiac death (Recognize the Warning Signs of Sudden Pediatric Cardiac Death, R. Slaven, BS, NREMTP) in the August 2011 issue of JEMS. The article’s title is just a touch misleading because it’s not assessment-based but the review of some of the causes of sudden cardiac death in children and young adults should peak your curiosity and give you a place to start if you’re interesting in further researching the topic.

 

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