[Annabelle07]

I need your help please---I am an OR Nurse returning to school after many years. I need your expertise in how to differentiate epigastric pain from MI. I thought ER Nurses would be the best source!
Not very good with these patient assessments----more used to just cutting them open and fixing them up after someone else diagnosed them! Thanks!

[RunnerRN]

Here's the big issue....a lot of times you can't. And a lot of times people come in w cco upper abd pn and end up having the big one (esp women). I'm sure you're asking about ways to differentiate with assessment skills, but sometimes it just isn't possible. Of course you'll get your EKG. Also look at the pt - if he/she is pale, warm, grey, most likely it isn't just epigastric issues at work. Most epigastric pain also isn't going to cause diaphoresis or SOB (although it can). Review what the pt has eaten in the last day. Find out if there is a radiation up and down from the throat to the stomach (not terribly reliable to differentiate). Also - obviously - if s/he tastes an acidic taste.
The problem with all of this is that many people come in thinking they're having an MI and all of their answers will reflect that. We often give a mixture of Donnatal, Viscous Lidocaine, and Maalox to differentiate (but I've been told that the lidocaine can also "numb" the anterior cardiac wall and decrease pain too.....so there goes that one as an absolute)

Overall I'd say it is a lot of visual assessment and gut reactions.
Good luck (not sure if I helped at all!!)

[Annabelle07]

Thanks!