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Emergency medicine > Chest pain and cardiac arrest > Flashcards

Chest pain and cardiac arrest Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Life-threatening causes of chest pain

A

Cardiac: ACS (e.g. STEMI)

Respiratory: Tension pneumothorax

Vascular: Aortic dissection, PE

Other: Oesophogeal rupture (Boorhave)

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2
Q

Common non-life threatening causes of chest pain:

A

Cardiovascular: Pericarditis, sickle cell crisis

Respiratory: Pneumonia, empyema

Chest wall: MSK, costochondritis, Bony mets, rib fracture

GI: Reflux, oesophogeal spasm, cholecystitis, peptic ulcer, pancreatitis

Other: Herpes zoster, cervical spondylosis

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3
Q

Spondylosis vs spondylolysis vs spondylolisthesis

A

Spondylosis: Degeneration of annulus fibrosis + osteophyte formation –> compression of spinal cord (common in cervical)

Spondylolysis: Fracture of vertebral arch (pars interarticularis)

Spondylolisthesis: Slippage of one vertebral disc voer another (usually L5/S1 but may occur in cervical)

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4
Q

Forms of ACS

A

Unstable angina: Chest pain +/- ECG changes, normal troponin

NSTEMI: Chest pain + ST depression/T-wave inversion/biphasic, trop rise (admission, 1h, 3h)

STEMI: Chest pain + ST elevation

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5
Q

Emergency management of ACS

A

Morphine + anti-emetic (metoclopramide 10mg)

Oxygen (IF HYPOXIC/LVF)

Nitrate: Sublingual, esp if hypertensive/LVF

Asprin 300mg PO

Beta blocker: bisoprolol 2.5mg if no evidence of shock, HF, asthma, heart block

Primary PCI if STEMI

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6
Q

NSTEMI management after MONA

A

Fondaparinux 2.5mg SC

Ticagrelor 180mg PO (or clopidogrel 300mg PO if low risk)

Bisoprolol 2.5mg if not CI

Chest pain nurse referral + admission + repeat trop at 6h

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7
Q

UA management after MONA

A

GRACE score >1,5% –> give clopidogrel

Consider fondaparinux

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8
Q

Secondary prevention of ACS

A

Beta blocker

ACE-inhibitor

Statin

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9
Q

STEMI criteria

A

ST elevation >2mm in >1 adjacent chest lead

STE >1mm in >! adjacent limb lead

New LBBB

ST depression + tall R-waves in V1-3 (posterior MI)

DON’T WAIT FOR TROPONIN WON’T ENTER CIRCULATION IN INFARCTION

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10
Q

Non-atherosclerotic causes of ACS

A

Infective: Emboli from endocarditis

Vasculitis

Cocaine

Hyperthyroidism

Severe anaemia

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11
Q

Risk factors leading to ticagrelor vs clopidogrel in NSTEMI

A

DM

PVD

CKD

Known coronary artery stenosis

age >60

previous stroke, TIA, MI, CABG

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12
Q

Causes of cardiac tamponade

A

Trauma

Pericarditis

Breast/lung cancer

MI > ruptured ventricle

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13
Q

Signs of cardiac tamponade

A

Low BP

High JVP, rises with inspiration

Pulse disappears with inspiration

muffled heart sounds

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14
Q

Hx in aortic dissection

A

Marfan’s, CTD, dilated aortic root

Tearing chest pain radiating to back + down spine

Collapse

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15
Q

O/E in aortic dissection

A

Focal neurology

L/R BP difference

Widened mediastinum on CXR (definitive is CT aortogram)

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16
Q

Investigation of suspected PE

A

Wells score >=2 –> CTPA/V/Q scan

Wells score <2 + PERC score >0 –> D-dimer

Wells score <2 + PERC score 0 -> Ruled out

17
Q

Hx of PE

A

Pleuritic chest pain

Haemoptysis

Breathlessness

Collapse

PMHx: Clotting disorder, malignancy, PE/DVT

18
Q

Ex + Ix in PE

A

Obs: Tachycardia, tachypnoea, Hypoxia, Hypotension, high JVP, RV heave

Auscultation: Pleural rub, loud P2, gallop rhythm

ECG: S1Q3T3, aVR STE, RBBB, RAD

19
Q

Rx in PE

A

Morphine + antiemetic

Oxygen: if hypoxic

C: S/c dalteparin 200U/kg OR fondaparinux 7.5mg

Alteplase 10mg if haemodynamically unstable

20
Q

Shockable vs nonshockable cardiac rhythms

A

Shockable: VF, pulseless VT

Non-shockable: Asystole, PEA

21
Q

Defib shock energy

A

150-360J biphasic

350J monophasic

22
Q

Factors reducing defibrillation success

A

Hypoxia, hypothermia

Acidosis, Toxaemia, electrolyte disturbance

23
Q

Frequency of shocks during ALS

A

CPR for 2 min –> shock –> keep repeating

24
Q

Medication during ALS of shockable rhythm

A

Adrenaline 1mg (10ml of 1:10,000) IV

Amiodarone 300mg

Give adrenaline every 4mins (i.e. every other shock) from 3rd shock onwards

Give amiodarone once at 3rd shock

Stop if ROSC

25
Q

Reversible causes of cardiac arrest

A

4Hs:

Hypoxia

Hypothermia

Hypovolaemia

Hypo/hyperkalaemia

4 Ts:

Toxins

Tension pneumothorax

Tamponade

Thrombosis (coronary/pulmonary)

26
Q

Medication during ALS of nonshockable rhyhtms

A

Give 1mg adrenaline IV immediately

Repeat every 4min

Emergency medicine (4 decks)

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