chest pain Flashcards
ecg what should you compare to
old ecg
gradual chest pain
gord
mi can be
pericardis , myocarditis
radiation pain
jaw mi
back - bilaiary , inferior mi
what were you doing at the time of the chest pain
ix order in chesst pain
troponin
d-dimer
chest xray
group and ssave
when can MI be atprical
elederly and diabetics s
widened mediastinum
aortic dissection
pe sx
pleuritic chest pain
haemoptysis
SOB
hypoxia and hypotension
what do you need to do for pe
wells score
rf for penumothorax
bullous disease eg copd , alpha 1
marfanoid looking
pericarditis sx
learning forward
pleurtic chest pain
small QRS complexes
pr depression
widespread st saddling across anatomical territories
gord sx
retrostnerla burning
metallic taste
radiating neck motuh
precusors like started on nsaid steriods spicy food
epigsatric abdo tenderner without rebound or guarding
sharp pain and pelruitc
precurosr heavy lift cough
reproducible by palpation
dx of exclusion
what is it
msk pain
two types of clots you get in MI
platelet rich clot - causing partial occulsion and intermittent ischaema - not st elveation or unstable angina
platelet nd thrombin rich clot - called a red clot - complete occlusion and continual ischaemia - st elevation
atypical findings of MI seen in
women
diabetics
elderly
afrocaribbean
ix if siuspecting acs
fbc
coagulation for baseline nothign abrnomal
uand e
lift
troponin
crp
troppnin raieed in
renal failur e
aoritic disseciton
shock
peri myocardiits
cardiomyopathy
do we need 2nd troponin 2 hours after
yes we do
why do you avoid high flow oxygen in acs
can increase free radical formation and worsen Ischaemia
trigger for narrow complex
caffeine
alcohol
recreational drugs
beta agonist
exercise
difference between physiologal sinus tachy and SVT
sinus tachy rate is under 150 and p waves are present
supraventricular tachycardia - rate is over 150 and p waves are absent
mx SVT
attach defib
peri arrest - pulmonary oedema, hypotension, MI , syncope - then DC shock - then escalate to anaesthetics
stable - vasalva-blow into syringe for as long as you can against thumb or syringe - lefs up and lower head therefore increasing venous return and pounding vagus
adenosine next - av block brief - need big cnanula with large flush and lift arm - 6 12 12 - risk of worsening arrhythmias so ensure als practioner is present just incase rare
use verapamil in asthma or copd instead
long QT or sick sinus syndrome get cardiology
post resolution of SVT what should you get
post reoslution ecg looking for ischaemia
routine bloods make sure no infectins anaemia or anything abnromally - potassium mg and calcium , hyperthyrodi too - troponin will be raised - chest pain preceed svt
outpatient echo
BB effective AVNRT
some require ablation of pathway if recurrent episodes
what are kerley b lines
fluid into intersitaial space causing straight lines
endotracheal tube how far from carina
5-7cm
if we have lost lung volume need to find where it has gone
look behind heart if more dense
stochastic changes due to raditaiotn leading to cancer
skin reddening
cataracts
hair loss
lung fibrosis
infertility
bone marrow damage
gi tract mucosal damage
nerve damage
10 day rule for iamging for preg
true
