CHEST PAIN Flashcards
What needs to be seen on an ECG to make a diagnosis of a STEMI suitable for thrombolysis?
- >2mm ST elevation in adjacent chest leads OR
- >1mm in adjacent limb leads OR
- new LBBB
How long should be left between serial troponins and what is considered a significant discrepancy in terms of %?
6 hours
20%
What score estimates mortality risk for UA/NSTEMI?
TIMI score
What is the GRACE score?
The GRACE Score is a prospectively studied scoring system to risk stratifiy patients with diagnosed ACS to estimate their in-hospital and 6-month to 3-year mortality.
Name the 6 key drugs in initial ACS management including dose and route
- aspirin 300mg PO
- clopidogrel 600mg
- oxygen 15L/min in hypoxic patients
- diamorphine 2.5-10mg IV PRN for pain relief
- Metoclopramide 10mg IV
- GTN spray
What is the ideal time from door to balloon?
What time is permitted?
- 90 minutes
- 12 hours
During PCI what additional drug is typically given?
additional anticoagulant e.g. heparin or fondaparinux
If PCI is not available within what period of time there should be thromobolysis with what medication?
- 2 hours
- tPa (streptokinase/alteplase)
What is the GRACE score used for?
To assess 6 month-3 year mortality risk following a diagnosis of ACS
What is the medical management of NSTEMI and UA?
Dual antiplatelet therapy with aspirin and clopidogrel
What is the change associated with Barrett’s oesophagus?
Stratified squamous to columnar
What is the definitive management of a tension pneumothorax?
Chest aspiration into 2nd ICS MCL
What is Virchow’s triad?
- Hypercoagulability
- Haemostasis
- Endothelial injury
What Well’s score is considered indicative of DVT or PE?
>2
What is the management for PE?
DOAC as bridging and actual therapy
You can place a vena cava filter in patients who continue to develop thrombi despite anticoagulation – but remember that implanting a filter without adequate anticoagulation will increase the risk of thrombus.
Thrombolysis may be used if the PE is deemed ‘Massive’ – 50mg alteplase – as long as no contraindications
What is the gold standard investigation for PE? What is the alternative and in what scenario should it be used?
- CTPA
- V/Q scan in cases with renal dysfunction
Name 3 causes of a transudate pleural effusion
- LV failure
- Cirrhosis
- Nephrotic syndrome
Name 3 causes of an exudative pleural effusion
- PE
- Infection- pneumonia
- Neoplasm
- TB
What criteria is used to distinguish between transudate and exudate pleural effusion?
Light’s criteria was developed in 1972 to help distinguish between a transudate and an exudate. The BTS recommend using the criteria for borderline cases:
- exudates have a protein level of >30 g/L, transudates have a protein level of <30 g/L
- if the protein level is between 25-35 g/L, Light’s criteria should be applied. An exudate is likely if at least one of the following criteria are met:
- pleural fluid protein divided by serum protein >0.5
- pleural fluid LDH divided by serum LDH >0.6
- pleural fluid LDH more than two-thirds the upper limits of normal serum LDH
What is the first line medical therapy for pericarditis?
High dose NSAIDs 9naproxen 250mg QDS) for 1-2/52, alongisde PPIs will ususally resolve symptoms
What is Beck’s triad and what is it a sign of?
- Distant heart sounds
- Distended JVP
- Decreased arterial blood pressure
What is the gold standard investigation of aortic dissection?
Name 3 other imaging modalities that can be used
MRI angiography
- Transoesophageal USS
- Transthoracic USS
- CT with contrast
What are the causes of delirium?
P - Pain
I - Infection
N - Nutrition
C - Constipation
H - Hydration
E - Endocrine + Electrolyte
S - Stroke
M - medication and Alcohol
E - Environmental
In STEMI, what period of time must PCI be available within? If PCI cannot be achieved within this time then perform fibrinolysis
120 m
After fibrinolysis what should happen to check effectiveness of treatment?
If treatment is not effective what should happen?
- ECG WITHIN 60-90m
- PCI
What glycaemic control should be initiated post-MI?
dose-adjusted insulin infusion
