This article by an emergency room physician in Texas providers a good summary for the evaluation of chest pain in the emergency room.
The article explains that "The decision to discharge a patient who presents with chest pain as the primary complaint should be made only after careful consideration of potential consequences. Patients with myocardial ischemia (MI), angina, pulmonary embolism, dissecting aortic aneurysm, or pneumothorax all can present with chest pain. Your evaluation and documentation should take into consideration all of these high-risk conditions."
The author explains the importance of documentation with these words:
Use the following guidelines to establish consistent documentation habits.
- Remember the chief complaint. Given the presenting symptom, document pertinent negatives that rule out high-risk possibilities.
- Document pertinent positives that support your diagnosis, treatment, and disposition of the case.
- Double-check your documentation to see whether the chief complaint, history, and your findings support the diagnosis.
- Directly address any suspicion of MI, pneumothorax, dissecting aneurysm, or pulmonary embolus. Verbalize your suspicions, and note them in writing.
This article was written over 20 years ago, but a professional liability insurer still considers it to be so valuable that it is included on its website as a resource for emergency room doctors.