A 34yr old came with pain probably muscle spasm at left side of chest,he has a h/o heavy weight lifting too What could be medicine which we can prescribe?
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musculoskeletal chest pain AND treatment
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2021 AHA ACC chest pain guideline acute chest pain emergency evaluation red flags
Do not prescribe for “muscle spasm” until cardiac and pulmonary causes of chest pain have been screened out. Heavy lifting can cause an intercostal or pectoral strain, but even reproducible chest-wall tenderness does not fully exclude myocardial ischemia.
Urgent ED evaluation now if pain is pressure-like, exertional, severe or persistent, or associated with breathlessness, sweating, nausea, fainting, palpitations, radiation to arm/jaw/back, hemoptysis, fever, or unilateral leg swelling. An ECG and, when indicated, serial troponin are part of acute chest-pain assessment in the ACC/AHA chest-pain guidance.
If examination supports an uncomplicated chest-wall muscle strain, with normal vitals and no red flags:
- Rest from lifting and avoid movements provoking pain for several days. Use ice for the first 24-48 hours, then heat if it helps.
- Paracetamol/acetaminophen: 500-1,000 mg every 6-8 hours as needed, maximum 3,000 mg/day for most adults. Use a lower limit or avoid if significant liver disease or heavy alcohol intake.
- Topical NSAID, such as diclofenac gel applied according to the local product label, is often a reasonable first option.
- If no contraindications, an oral NSAID may be used briefly, for example ibuprofen 200-400 mg every 6-8 hours with food, maximum 1,200 mg/day OTC, for 2-3 days. Avoid it with peptic-ulcer/bleeding history, kidney disease, uncontrolled hypertension, heart failure, anticoagulants, NSAID allergy/asthma, or pregnancy.
- I would not routinely start a sedating muscle relaxant for undifferentiated chest pain. If spasm remains prominent after assessment, it should be selected by the treating clinician after checking driving/work risks, alcohol or sedative use, comorbidities, and drug interactions.
Reassess within 24-48 hours, or sooner if symptoms worsen. Pain that is sharply localized, reproducible by palpation or resisted arm/chest movement, and began after lifting makes a strain more likely, but it is not enough alone to safely rule out more serious causes.
How to differentiate between bacterial and viral fever?
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CDC differentiate viral bacterial infections antibiotics testing symptoms fever
You usually cannot reliably differentiate bacterial from viral fever by fever pattern alone. Both can cause high temperature, body aches, fatigue, sore throat, cough, vomiting, or diarrhea. The diagnosis comes from the overall history, examination, illness course, and sometimes tests.
| Feature | More suggestive of viral illness | More suggestive of bacterial illness |
|---|---|---|
| Course | Improves gradually within about 3-7 days | Persists, deteriorates, or improves then becomes worse again |
| Associated symptoms | Runny nose, sneezing, hoarse voice, cough, red/watery eyes, diffuse aches | A clear localized focus: painful urination, focal ear pain, unilateral sinus/facial pain, cellulitis, pus, focal chest signs |
| Examination | Diffuse upper-respiratory findings | Focal consolidation, tonsillar exudate with compatible presentation, otitis, urinary findings, skin infection, etc. |
| Tests | Viral PCR/antigen may identify a virus | Culture, urine testing, rapid strep test, imaging, or selected blood tests may identify bacterial disease |
| Antibiotics | Do not treat viruses | Helpful only for confirmed or strongly suspected bacterial infection |
Important cautions
- High fever does not mean bacterial. Influenza, COVID-19, dengue, and many other viral illnesses can produce high fever.
- Yellow or green mucus does not by itself mean bacterial.
- A raised white-cell count, CRP, or procalcitonin may support the clinical impression but is not definitive alone. For example, procalcitonin does not reliably distinguish viral from bacterial community-acquired pneumonia at a single cutoff. Fishman's Pulmonary Diseases and Disorders, section “Procalcitonin,” lines 1940-1942.
- Do not start antibiotics simply because fever is present. They do not treat viral infections and can cause adverse effects and antibiotic resistance. The CDC antibiotic information states that antibiotics treat bacterial, not viral, illnesses.
A practical clue: “double worsening”
For a respiratory illness, a bacterial complication is more plausible when symptoms:
- last more than 10 days without improvement,
- are severe from the start, such as fever at least 39°C/102°F plus purulent nasal discharge and marked facial pain for 3-4 days, or
- improve then worsen again after 4-7 days.
This pattern is specifically used for suspected bacterial sinusitis in CDC guidance, but it is not a universal rule for every fever.
Seek urgent evaluation
Prompt assessment is needed for fever with confusion, severe headache or stiff neck, breathing difficulty, chest pain, persistent vomiting or dehydration, new purple/non-blanching rash, severe abdominal pain, seizures, very low urine output, or marked drowsiness. Also seek assessment for fever in infants under 3 months, immunocompromised people, pregnancy, or persistent unexplained fever.
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