What are the two most critical chief complaints in a 20-year-old patient in primary care?

From the Guidelines

The two most critical chief complaints in a 20-year-old patient in primary care are suicidal ideation and severe chest pain. These complaints are prioritized because they can represent immediately life-threatening conditions requiring rapid intervention, and delaying care could result in preventable death in an otherwise young, healthy individual. Some key points to consider in evaluating these chief complaints include:

• Suicidal ideation requires immediate assessment using standardized tools like the Columbia-Suicide Severity Rating Scale, followed by appropriate safety planning, potential psychiatric referral, and consideration of hospitalization if the risk is high 1.
• Severe chest pain, while often musculoskeletal or anxiety-related in this age group, must be thoroughly evaluated to rule out serious conditions like pneumothorax, pulmonary embolism, or even cardiac issues such as myocarditis or aortic dissection 1.
• An ECG, chest X-ray, and cardiac enzymes may be necessary, with immediate referral to emergency services if vital signs are unstable or if the pain is severe, radiating, or accompanied by shortness of breath 1.
• The evaluation of patients with suspected acute coronary syndromes should include a history and physical examination, timely electrocardiographic acquisition and interpretation, and assessment of cardiac troponin 1.
• A thorough description of the evaluation of patients with suspected acute coronary syndromes is provided in the “2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain” 1. Any patient expressing thoughts of self-harm should never be left alone, and severe chest pain should be evaluated promptly to rule out life-threatening conditions. The provided guidelines and algorithms can help guide the initial evaluation and management of patients with these chief complaints 1.

From the Research

Chief Complaints in Primary Care

The two most critical chief complaints in a 20-year-old patient in primary care are:

• Headache
• Chest pain or other cardiovascular-related issues are not explicitly mentioned in the provided studies as the top complaints, but headache is a prevalent issue

Reasons for Headache Complaints

Some reasons for headache complaints in primary care include:

• Primary headaches, such as migraines or tension-type headaches 2, 3
• Secondary headaches, which may be caused by underlying medical conditions, such as subarachnoid hemorrhage or myocardial infarction 4
• Lack of effective pain management or inadequate diagnosis 5, 6

Management of Headache Complaints

Management of headache complaints in primary care may involve:

• Accurate diagnosis and evaluation to rule out underlying serious conditions 2, 5
• Effective pain management, including the use of antiemetics or other therapies 6
• Patient education and follow-up to address ongoing headache issues 3, 5
• Referral to specialist care, such as a neurologist, if necessary 6