Original Publication
Open Access

The Undifferentiated Chest Pain Patient - An Introduction to the ED Approach to the Patient

Published: August 8, 2013 | 10.15766/mep_2374-8265.9482

Included in this publication:

  • Case 1 - STEMI.docx
  • Case 1 CXR.JPG
  • Case 1 EKG.pdf
  • Case 2 ACS.docx
  • Case 2 CXR.JPG
  • Case 2 EKG.jpg
  • Case 3 AD.docx
  • Case 3 CXR.jpg
  • Case 3 EKG.jpg
  • Case 4 CXR.jpg
  • Case 4 EKG.jpg
  • Case 4 PTX .docx
  • ED Approach to Chest Pain Overview.doc
  • ED Approach to Chest Pain Presentation.pptx
  • Instructor's Guide.docx

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: In emergency medicine, we evaluate and treat patients with chief complaints and need to have a thorough understanding of elements of the domains of training during our care. This educational module was developed to demonstrate these multidimensional aspects of emergency department (ED) care. Given this, the module ties in the various aspects of clinical medicine, emphasizing to the students that clinical care involves all aspects of their discipline including basic science, clinical science, research, and interprofessionalism. Our session was specifically designed to give third-year medical students the opportunity to make clinical decisions and apply their prior education and research skills to patient care. For many, this is the first time they were responsible for direct care of a patient. We chose the chief complaint of chest pain as it is a common one with a wide variety of potential problems and diagnoses, and brings to bear elements of all aspects of medicine. Methods: This module represents a multidisciplinary approach to the evaluation of a patient with chest pain in an ED setting, and is designed for medical students of various levels. Students are initially in a large-group setting (group size may vary), where they receive a didactic lecture regarding the emergency medicine thought process and an introduction to the educational activity. They are then divided into small groups to perform a case-based literature search on specific topics, and then return to the large group where four facilitated simulations are performed (ST myocardial infarction, acute coronary syndrome, aortic dissection, and pneumothorax). A discussion regarding the integration of clinical sciences, basic sciences, research, and interprofessionalism occurs at the end. Results: At the end of the session, students filled out an evaluation using a 5-point Likert scale (5 = strongly agree). These individual scores were then averaged by item. To the item “This experience has helped me develop the skills necessary to care for patients,” students gave an average score of 4.27. To the item “I was challenged in my thinking and decision-making skills,” students gave a score of 4.17. To the item “This experience enhanced my understanding of the integration of basic and clinical sciences,” students gave a score of 4.21. To the item “This experience enhanced my understanding of the application of interprofessionalism,” students gave a score of 3.76. Discussion: At the Virginia Tech Carilion School of Medicine, medical student education is guided by the various domains of medicine – basic science, clinical science, research, and interprofessionalism. During their third year, the medical students are brought back from clerkship rotations for large-group sessions run by each department, highlighting how that individual department’s care and approach to the patient are guided by and incorporate all of the different domains. This educational course was developed to demonstrate that multidimensional aspect of ED care.

Educational Objectives

By the end of this session, learners will be able to:

  1. Ask initial historical questions focused on creating a differential diagnosis to patients with acute chest pain.
  2. Perform a focused physical on patients with acute chest pain.
  3. Create a differential diagnosis for emergent causes of chest pain.
  4. Identify features which make patients higher risk for the following diseases: myocardial infarction, aortic dissection, pneumothorax.
  5. Use an EKG to localize the site of a cardiac lesion.
  6. Order appropriate diagnostic testing to evaluate causes of pain based on information gathered from history and physical.
  7. Initiate evidence-based treatment of patients with chest pain.
  8. Describe the anatomy and pathophysiology of the following diseases: myocardial infarction, aortic dissection, pneumothorax.
  9. Describe a treatment team in various settings.
  10. Explain roles of various providers and health care workers in the treatment of acute chest pain.

Author Information

  • Corey Heitz, MD, MS: Carilion Clinic
  • John H. Burton, MD: Carilion Clinic
  • Timothy J. Fortuna, DO: Carilion Clinic
  • Damon R. Kuehl, MD: Carilion Clinic
  • John C. Perkins, MD: Carilion Clinic
  • Melanie K. Prusakowski, MD: Carilion Clinic

None to report.

None to report.


Heitz C, Burton J, Fortuna T, Kuehl D, Perkins J, Prusakowski M. The undifferentiated chest pain patient - an introduction to the ED approach to the patient. MedEdPORTAL. 2013;9:9482. https://doi.org/10.15766/mep_2374-8265.9482