When you want, or need, to know more than the superficial, such as when you are
where there is no access to a physician.
Prototypically: Medicine at Sea
This medical information is provided for education purposes only. I am making no attempt to practice medicine over the internet. This is being written to give some basic knowledge for those that are physically isolated from access to professional medical care, such as sailors at sea. This is to help in deciding whether an emergent medical condition exists, how to initially deal with it, and whether evacuation is needed. It is by no means exhaustive or meant to replace personal medical attention. Please do not contact me regarding your personal condition. Over the years I have received many emails from people asking for help with their personal chest pain, or whatever. Sometimes they write during acute pain. This is ridiculous. You can't practice medicine over the internet. If I find their email, after it has been filtered by my spam filter, it may be days or weeks later. My response, if any, will be to contact their regular provider. Even a bad doctor in person is better than an email. Please use this information in the spirit in which it is intended.
Sincerely, Mark R. Anderson, M.D.
my other interests
Problems in which the primary symptom is in the chest.
Chest Pain and Trouble Breathing
Dx: Where When Type Tender SOB Cough Sputum B.S. T° N/V Treatment
Hyperventilation (Breathing too much for your needs)
+/- - Tight - + - - Nl. - - Paper bag
Usually emotional trigger. Numbness of lips and fingers. Breathing deep and fast usually.
CHEST WALL PROBLEMS:
Costochondritis (rib joint inflamation)
Rib joint Pleuritic Sharp + - - - Nl - - NSAID (ASA)
Localized tenderness at rib joint. May be due to trauma or recent virus.
Pleurisy (inflamation of lung surface &/or chest wall lining.
Local Pleuritic Sharp - - - - Rub - - NSAID
Point Pleuritic Sharp + +/- - - +/- grate - - Ice, analgesia
If truly short of breath (not just hurting), there could be lung injury, possibly serious. Pressure on
specific ribs reproduces pain.
Angina (Heart pain)
Central Exertion Tight - +/- - - Nl. - - Rest, NTG
Lasts 5-30 min. Dull, squeeze, pressure. May radiate to arms (esp. L), jaw, back, upper abdomen.
Same as angina but increasing in severity, duration, and/or frequency. Risk of progression.
Treat ASA, nitroglycerin, anticoagulation. Needs hospital.
Myocardial infarction (MI), (Heart attack)
Central ? Tight - +/- - - Nl. - +/- Clotbust,ASA
Like angina but lasts over 30 min. Starts w/ exertion or not. More associated symptoms.
CHF: Congestive Heart Failure
No pain unless due to MI - W/ exertion - - Rales - - Water pills
Waking up SOB and to urinate, SOB lying down, +/- ankle swelling. Other treatment also.
Pericarditis (Inflamation of the heart surface and surrounding sac)
Central Position Variable - +/- - - Nl. - - ASA
Pain better sitting up and leaning forward. May inc. w/ breath, swallow.
PSVT (Paroxysmal SupraVentricular Tachycardia) Sudden rapid regular pulse.
+/- pain Sudden - +/- - - Nl. - - Vagal maneuver
Pulse regular and over 150/min. Lasts seconds to hours. Avoid caffeine, tobacco,alcohol.
No pain Tight - + +/- Clear Wheezes - - Inhalers, steroids
Epinephrine (adrenaline) injection if no bronchodilator inhalers.
Inhalers: albuterol (Proventil, Ventolin), Steroids: prednisone
+/-mid cough Harsh - - + +/- +/-coarse +/- - +/- antibx
Antibx considered if over 3 wks, or several days of green or yellow sputum.
Antibx not shown to be effective unless there is already chronic lung disease
+/- 1side Pleuritic Sharp - +/- + + grn/yel Rales + - Antibx
If symptoms are mild, may skip antibx. Rales at site of pneumonia.
Pneumothorax (collapsed lung)
1 side Pleuritic Sudden - + - - Dec’d 1side - - Needle if severe
Spontaneous. Partial or complete. Often tall thin people. Usually a healthy person can get by while the lung is collapsed. Can also be due to rib fracture. Rarer type, (tension pneumothorax), builds pressure and pushes organs across chest. That’s lethal and must be reexpanded.
Pulmonary embolus (clot to lung)
Local Pleuritic Sudden - + - - Nl. - - Anticoag.
From clot in leg usually (phlebitis). Can be lethal. Phlebitis may not be obvious.
Pyrosis (Heart burn)
Central Steady Burn - - - - Nl. - +/- Antacids,H2 blkr
Cardiospasm (esophagus cramp)
Central Steady Tight - - - - Nl. - +/- Antacids
May mimic heart attack. Try hot water. Look for association with food or burp.
H2 blocker: Tagamet, Pepcid, Axid, Zantac
Inhalers for asthma: Albuterol (Ventolin, Proventil), Primatene in a pinch (more dangerous).
NSAID: Non-Steroidal Anti-inflamatory Drug - ASA, ibuprofen, naproxen, ketoprofen, many others.
Vagal maneuvers: Valsalva (hold deep breath and bear down), put face in cold water, cover face w/ cold
wet washcloth, massage one carotid under jaw (more risky).
Water pills: Diuretics, e.g. Lasix (furosemide)