Office of Education
Yale University
School of Medicine
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New Haven, CT
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Charlotte Scarlotti: Interview

Dr. Grey: Charlotte, what's the matter?

Charlotte: I have a pain in my chest, right in the middle.

Dr. Grey: When did it start?

Charlotte: Just after I woke up, about half an hour ago.

Mike: She looked so pale I just put her in the car and drove her here.

Dr. Grey: Do you have pain anywhere else, in your chest, arms, back, or neck?

Charlotte: I can feel it in my arms.

Dr. Grey: How severe is the pain, say on a scale of one to ten, where ten is the worst?

Charlotte: Ten.

Dr. Grey: Any trouble with your breathing?

Charlotte: No.

Dr. Grey: Mona, I'm going to need some help.

Self-assessment question:

Based upon this brief interview, which of the following would you recommend that Dr. Grey ask Mona to do as he performs a rapid physical examination?

a. Call for an ambulance
b. Bring in the iv tray
c. Initiate nasal oxygen
d. Obtain an EKG
e. Administer chewable aspirin
e. Administer subcutaneous morphine

The correst anwer is f. The American College of Emergency Physicians recommends that patients with crushing chest pain have an immediate clinical examination, EKG, oxygen, IV access, aspirin, and pain control beginning with nitroglycerine. Morphine would be added if pain fails to resolve with nitroglycerine. What is the recommended dose of aspirin?

Next: Physical examination