Assess VS and general appearance to determine if immediate treatment is needed. Do not immediately assume that the etiology is cardiac. Evaluate the degree of pain and the impact that it has on the patient's life. Determine if the pain is part of an underlying chronic condition. Consider further testing if history or physical exam is concerning. Avoid expensive and invasive testing when pain is chronic and history and physical examination is benign.
Appearance, acute distress, anxiety, chronic appearance
Anxiety, depression, substance abuse
HSM, epigastric tenderness