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Chest Pain in Patients Seen in Emergency Clinics

herbert Berger, MD
JAMA. 1977;237(2):119. doi:10.1001/jama.1977.03270290019011.
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To the Editor.—  Unfortunately, few emergency rooms possess clinicians of the diagnostic caliber of Dr Kleiger ("Chest Pain in Patients Seen in Emergency Clinics," 236:595, 1976). Instead, the emergency room is often staffed by surgically-oriented physicians who are interested in fractures and lacerations. In community hospitals, the emergency room is handled by interns, most of whom emanate from foreign schools and function at various levels of competency. Language barriers are common.Therefore, I have preached that chest pain is an emergency to be preceded only by an arterial hemorrhage. Electrocardiograms are not to be taken, x-ray films not ordered, and no enzyme studies nor extensive history and physical examination done. Such patients should be given lidocaine intravenously or intramuscularly in the emergency room and should be conducted at once to the intensive care unit.While this procedure will certainly admit some patients who do not need it, the error in


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