Chapter 12: Clinical Investigations

James is a 25-year-old personal trainer who attends to you as the triage nurse in the emergency department on a Tuesday morning. He states he has had a gradual onset of left sided chest pain since this morning. It is not radiating anywhere and is worse on movement. He states he had been training hard with weights over the weekend for a competition. He is a non-smoker, has no past medical or family history and takes no medication. His observations are within normal limits. 

Questions

  • What investigation may be appropriate at triage?
  • What investigation would not be appropriate at triage?

Answers

  • Electrocardiograph (ECG).  Any patient presenting with chest pain to the ED should have an ECG within 10 minutes to monitor rate, rhythm and possible ischaemia or infarction.
  • Troponin blood test. The history for Jack is not consistent with cardiac chest pain and more consistent with musculoskeletal pain. He also has no cardiac risk factors.