DRABCDE - chest pain

Question 1

You are called to see Mr. Withers on the Coronary Care Unit
who is complaining of chest pain and dizziness. He had an MI 3 days ago.
Please assess and treat.

Answer 1

Latest observations: HR 100, BP 110/ 80, RR 20, Sats 94% on air, Temp 36.2

Patient meets PERT criteria- student should call for help. i think this is a bit contentious but if anything seems abnormal then call them, better safe than sorry.

Question 2

entry steps after calling the PERT team

Answer 2

D Washes hands, safe to approach.

R Patient is fully responsive

Question 3

airway assessment

Answer 3

Airway:

Look
Feel
Listen
Measure
Treat

Airway is clear

Question 4

breathing assessment

Answer 4

Breathing:

Look
Feel
Listen
Measure
Treat

Cyanosed, distressed, trachea is central, normal chest expansion.

Symmetrical chest movement, nil on percussion.
Clear.

RR 20, Sats 94% on air.

Administer high concentration of O2 via non-rebreathe mask
(oxygen mask with reservoir bag) unless contraindicated. If
choosing a fixed oxygen method student titrates accordingly. (sats improve to 98%). ABG. CXR.

Question 5

circulation assessment

Answer 5

Circulation:

Look
Feel
Listen
Measure
Treat

Grey, clammy, JVP not visible, patient in obvious pain.

Cool, clammy, weak/ thready pulse.

Normal heart sounds.

HR 122, BP 100/ 80, cap refill 4 secs, urine output 30mls/ hr,
Temp 36.2. ECG

Cannulate, bloods (FBC/ U+E), start fluid challenge, MONA.

Question 6

disability and exposure assessment

Answer 6

Disability
AVPU
Alert, BM 6mmols.

Exposure

Pale, sweaty.

Full systems examination. Write notes, look in medical notes, hand over (cardiology). Serial ECGs.