Identifying Ischemic Chest Pain through the P Q R S T Method
P…what PROVOKES the onset of Pain..
– What was the patient doing when the pain started?
– What did he do to relieve the pain?
– What makes the pain worse?(movement..,deep breathing.. coughing… exertion?)
Q…What is the QUALITY of the Pain?
– a description of the pain, what was it like?..(burning..,pressure..,sharp..,excruciating..,stabbing?)
R…Does the Pain RADIATES to other parts of the body?
– does it radiate to..(neck.., left shoulder/arm..,jaw..?)
S…How SEVERE is the Pain?
– Gauging the intensity of pain with 0-10 scale
– Or through facial expression when patient is unable to express d/t dementia or unable to talk because of severe pain
T…What was the TIMING of the onset of Pain?
– When did the pain start?
– Is it a new pain? or a usual pain?
– Has the pain changed or has it progressed/more intense and longer?
Analysis and Important Points:
Knowing what provokes or precipitate pain would make you think of other kind of chest pain aside from Ischemic heart pain. PLEURETIC chest pain which is worse with inspiration, coughing and deep breathing secondary to inflammation of the pleura or lungs are described as sharp and stabbing pain. This is usually caused by an infection or irritant that invaded the lungs. eg.. pleurisy, PE(a clot obstructing the exchange of 02 and C02),viral or bacterial infection of the lungs or even malignancy. A chest pain reproduced by palpation of the chest could be referred as muscle pain. Ischemic chest pain is caused by lack of oxygen to the myocardium caused by insufficient and or obstruction of blood flow that supplies oxygen to the cardiac muscle. Pain can be described as pressure, stabbing, excruciating or sharp. It is usually accompanied by diaphoresis, nausea, and shortness of breath which could be secondary to severe anxiety caused by the fear of doom and the body systems reaction to an abnormality. The radiation to the proximal part of the body from the point or origin of pain is an evidence of ischemia spreading to the nearby tissue. The severity of pain becomes alarming when it becomes prolonged and unrelieved denoting high possibility of infarction or death of the cardiac muscle. The timing and onset of pain is significant for the successful intervention and maintenance of life. Immediate identification of a myocardial infarction from the time the patient presented to ER is crucial for a successful PCI and preservation of life.
1. Marianne Chulay,Suzanne M. Burns. Assessment of chest pain. AACN Essentials of Critical Care 2nd ed.
2. Pleuritic Chest Pain – Symptoms, Causes and Treatment
3. Assessment of Pain: Questions to Consider during Assessment of …