Chest Pain in HS

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Hi friends!

I'm at the high school level. I've been seeing a lot of these kiddos coming in with c/o chest pain, usually rated as severe, "pressure-like" substernal pain that sometimes radiates to the left shoulder/arm ? Like a prudent nurse, I assess appropriately; usually BP is a little high, pulse normal, no SOB, diaphoresis, distress, normal abdominal assessment, lung and heart sounds are normal, etc. Basically, there are no objective s/s to alert me that there is a cardiac or respiratory event going on. However, my background is in cardio so my brain can't help but make itself see a potential problem that might not be there. I'm afraid that even if my assessment is normal and I send them back to class, they'll pass out and I'll eventually be coding them later ? So just to be safe, I've been sending these kids home, but I don't want to be sending these kids home all of the time.

Any fellow HS (or even MS) nurses, how do you handle this at your school??

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Specializes in ICU/community health/school nursing.

Keep your cardiac brain. You'll need it. But also:

Dehydration and stress can make you feel wonky with normal heart sounds. Normal treatment is rest and water. 20-minute disco nap works wonders.

Ask about caffeine consumption. If you slammed three Monster energy drinks....your chest will hurt.

Did you just run a mile?

How often are you using that asthma inhaler?

Ask about E-cigarette use. Chest "pain" might actually be your lungs filling up with goo from the toxins.

Ask - anything else you haven't told me that's relevant? I had a kid with 10/10 chest pain, increased resp rate, elevated BP - and what he didn't tell me was that he was in a low-speed accident that AM with seatbelt and airbag deployment and that he was scared for dad to find out.

Hope this helps!

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in my experience, chest pain/pressure in HS students is usually stress/anxiety. Plus everything rubyjane said ?

They do not always make the smartest choices, and they're not always forthcoming about everything that's going on. So they may come to you presenting with these symptoms, and what you have to pull out of them is that they haven't eaten all day, only drank a monster for lunch, have a test today and two tomorrow... or whatever the case may be.

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Specializes in school nursing.

I agree with jne, most of my experiences with high schoolers is anxiety and stress. And energy drinks combined with exercise...

However, my ER brain always tells parents that I still can't rule anything out definitively, so I give them the ultimate choice.

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Specializes in School nursing.

I'm seeing more of this in athletes with a vaping history.

But also stress. And dehydration. Or both stress and dehydration.

And my school is next to a Dunkin Donut and 7 Eleven. HS student live off of caffeine, coolatas. And oh, no real food ;).

But I will still home if needed.

I have a maternity sub covering the other school in my district and she is coming from Med Surg nursing. I told her that school nursing is "Looking for the horse first, then look for Zebras" vs "Look for Zebras, then Horses when Zebras aren't found."

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Specializes in school nursing, ortho, trauma.

Im in the middle school level. I give all of my chest pain c/o a full eval as well, and in the absence of anything that would raise suspicion I will normally have them rest under my observation for a bit then rtc. Very often at my level the chest pain occurs due to costochondritis, tender breasts due to hormonal shifts or development - however the kids find this hard to describe, or palpitations from sugar / caffeine or reflux from their very healthy diets.

I will generally call home as an FYI for this and if the parent asks if they should take for further eval, I tell them that calling their child's md to get further advice is always a good move. I never discourage a parent from seeking further assessment.

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Specializes in ICU/community health/school nursing.
22 hours ago, Flare said:

Very often at my level the chest pain occurs due to costochondritis, tender breasts due to hormonal shifts or development - however the kids find this hard to describe, or palpitations from sugar / caffeine or reflux from their very healthy diets.

OOOH - add have you been coughing today. Nice call. I learned a new thing.

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Specializes in school nursing, ortho, trauma.

oh yep - i ask about coughing too. Sore intercostals are also a reason. Kids

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