F. The Standard Care:

The Standard of Care for evaluation a patient presenting to the ED with chest and abdominal pain includes, but is not limited to, the following elements:

1. The standard of care for the evaluation of chest and abdominal pain mandates extreme prudence and a conservative approach with admission for the majority of cases where the diagnosis is not certain. This is the case primarily because the presence of a potential life-threatening condition cannot always be adequately ruled out with the tools present in the ED. This is particularly the case with acute coronary syndromes.
   
2. The standard of care includes performance of a complete and thorough history and physical examination. History must include or exclude the presence of risk factor for life threatening illnesses such as MI, aortic dissection, and pulmonary embolus.
   
3. An EKG is never contraindicated, and is almost always necessary when evaluating any abdominal pain radiating to the chest, or any isolated chest pain. This is particularly true when there are multiple cardiac risk factors.
   
4. The standard of care includes obtaining Cardiac Enzymes in the setting of symptoms consistent with the acute coronary syndrome. This is especially true if the patient possesses multiple cardiac risk factors.