Chest pain

Template

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Likely causeChoose one

FeaturesChoose any

Concerning features presentChoose any

Concerning features absentChoose any

ExamChoose one

ECGChoose one

Other testingChoose any

TreatmentChoose one

SportsChoose one

ReferralChoose any

DispositionChoose one

Follow-upChoose one

Follow-up reasonChoose anyJoins the line above

Counseling paragraphChoose oneParagraph

CounselingNot in the note with these choices

Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Chest pain
• Likely musculoskeletal chest wall pain
• Features typical of benign chest pain: sharp, brief, localized, and changing with position or breathing
• No chest pain with exercise, fainting or near fainting with the pain, palpitations, pressure radiating to the neck or arm, sweating, shortness of breath, or nausea with the pain, declining exercise tolerance, history of heart disease or Kawasaki disease, or family history of sudden cardiac death before age 50, cardiomyopathy, or inherited heart disease
• Reassuring cardiac and lung exam
• ECG not indicated given typical features and a reassuring exam
• Recommended motrin as needed, with warm or cold compresses
• Follow up if not improving

Chest pain in children is rarely caused by the heart and most often comes from the muscles and cartilage of the chest wall; it can come and go for days to weeks. Recommended supportive care with motrin as needed, with an emphasis on warm or cold compresses and rest from activities that make the pain worse. Return precautions given including chest pain with exercise, fainting, a racing or irregular heartbeat, trouble breathing, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Likely cause (musculoskeletal, costochondritis, precordial catch, reflux, exercise-induced bronchospasm, stress, cardiac concern)
Typical benign features
Concerning features present or absent (exercise, fainting, palpitations, radiating pressure, heart or Kawasaki history, family history)
Exam: reassuring, reproducible, abnormal heart exam, wheezing
ECG not indicated, normal, ordered, abnormal
Chest x-ray, spirometry
Motrin and compresses; Famotidine trial; Albuterol trial; reassurance
Hold sports until cardiology vs okay
Paragraph per branch (chest wall, reflux, EIB, cardiac)

Return precautions in the template

chest pain with exercisefaintinga racing or irregular heartbeattrouble breathingfever

Sources

Few formal guidelines cover this topic, so the template also leans on expert opinion.