Chest pain in the office: initial management

Chest pain is one of those events that the HOF professional hopes never to see, but it happens in any office that sees patients for long enough. The person may arrive already feeling it, feel unwell during the injection from pain, anxiety or a reaction, or call the next day with tightness in the chest. What decides the outcome is how quickly it is recognized and help is called.

This text is a review for the team to prepare, not a clinical protocol. Management belongs to the qualified professional, according to their life support training and the rules of their professional council.

Why does chest pain matter so much in the office?

The HOF office usually sees healthy adults, but also people with uninvestigated cardiovascular risk factors. The stress of the visit, the pain of the needle, fasting, the heat of the room and anxiety can trigger or reveal a condition that had been silent.

Some possible causes, without exhausting the list:

• Cardiac, such as acute coronary syndrome, arrhythmias and, more rarely, other emergencies.
• Pulmonary, such as embolism, pneumothorax or an asthma attack.
• Digestive, such as reflux and esophageal spasm.
• Musculoskeletal, which usually worsen with movement or palpation.
• Emotional, such as an anxiety or panic attack.

In the office you have no test to tell them apart. The safe reasoning is to treat it as serious until an emergency service says otherwise.

What are the warning signs?

The more signs together, the greater the urgency. But the absence of one does not reassure: cardiac pain is not always the classic kind, and it can be less typical in women, older adults and people with diabetes.

What should you do in the first minutes?

The sequence below is an organizing guide, not a substitute for hands-on life support training.

The decision to give any medication, including those that appear in emergency protocols, depends on training, assessment of the case and the patient's conditions, such as allergies and use of other drugs. Do not improvise: follow the protocol your training and your service adopt.

What to ask and what the medical history can anticipate

A good part of safety comes before the procedure. The medical history should ask about heart disease, hypertension, diabetes, high cholesterol, smoking, family history of early heart attack, medication use and previous episodes of chest pain or fainting. See the full outline in medical history in HOF.

Patients with known cardiovascular disease deserve attention regarding anesthetics with vasoconstrictor, especially in larger volumes. The topic is discussed in heart disease and anesthetics with vasoconstrictor, and the decision to treat or postpone may require an opinion from the treating physician.

Pain after the procedure: what if it comes by phone?

Sometimes the notice arrives by message: "I have tightness in my chest". The instruction to the patient is straightforward: seek emergency care or call SAMU 192, without waiting for a reply from the office. Chest pain is not a complaint to resolve by phone or by photo.

After the care, contact the family or the patient to learn the outcome, and document it.

Equipment and team preparation

An office that performs injectable procedures should have an emergency plan: a list of phone numbers in view, the full address to give SAMU, a clear path for a stretcher and an emergency kit with checked expiration dates. What to put together is in emergency kit for the HOF office.

Hands-on practice is worth more than a poster on the wall. A periodic simulation, described in emergency drill with the team, quickly shows who knows where the AED is, who calls emergency services and who stays with the patient.

Records and documentation

Document what happened with the time, without interpretation. Write down the symptoms reported, the signs observed, the measures taken, who was called, at what time, where the patient went and the companion's contact. The general record template is in recording the emergency in the office and the storage of documents is in patient records and documentation in HOF.

If in doubt about reporting to authorities, liability insurance or your council, talk to the technical lead and to the legal advisors of your service.

Particular situations that cause confusion

The patient who says it is always like this

Some people live with recurrent chest pain, already investigated, and may downplay the symptom. Even so, an episode during a procedure deserves the same respect: a chronic condition may have decompensated, and the stress of the visit is exactly the trigger. Ask them to describe whether the current pain is the same as before, stronger or different, and document it.

Symptoms that appear with anesthesia

Local anesthetics in larger volumes or injected into a vessel can cause palpitations, dizziness, a metallic taste and ringing in the ears, which the patient sometimes describes as tightness. These symptoms call for immediate interruption and monitoring, and should not be treated as simple nervousness. Management of systemic reactions to lidocaine follows the life support protocol and each professional's training.

Care without backup

Anyone who works in places without a team needs to think about SAMU response time, access to the address and the presence of another person who can help. Working alone, with no one to call and accompany, increases the risk when something happens.

In short

Chest pain in the office is not to be interpreted, it is to be referred. Stop, position, call emergency care, monitor and document. The rest, prevention, medical history and team training, is what makes those minutes count.