EM Flashcards
Immediate care for suspected MI
ABCs, stabilization, resuscitation, IV, O2, monitors, ECG, +/- CXR
ACS epidemiology
> 6 mil americans w/CAD
500K deaths/yr in US from CAD
4 mil ED visits/yr for ACP
$100B/yr
ACS etiology
ischemia vs. fixed atheroslclerotic lesion vs. evolving plaque/thrombus vs. spasm
ACS risk factors
smoking, HTN, DM, HL, age, FH (CAD age <55 1st degree relative), CAD, PVD
cardiac risk factors = poor predictors of ACS in ED
ACS PE
normal cardiopulmonary = most common. S3 in 15-20% of pts. w/MI, chest wall TTP in 15%
cardiac markers
CK-MB = >90% sensitive for MI 5-6 hrs later, only 50% earlier. elevate @3-12 hrs, peak @18-24rs. trop = Tn-I similar to CK-MB but duration is 5-1 days. Tn-T is less sensitive but is an independent marker for CV risk
ACS Tx
OH BATMAN
O2, heparin, BB, ASA, thrombolytic, morphine, anti-platelet, nitrates
ASA
inhibits thromboxane A2, decreasing PLT aggregation
nitrates
decrease preload and after load, increase coronary perfusion
BB
decrease infarct size, CV complications, and mortality
cocaine CP
6% have MI, 20-60% have transient ischemia, can be delayed hr-days. etiology: spasm, inc. O2 depend, clot formation, accelerated atherosclerosis w/LVH. Dx: Tn:I is better, ECG and CK-MD = worse. Tx: benzos. avoid BBs!
aortic dissection epi
Stanford A involves ascending aorta (80%), B is descending only. inc. risk in pts >50 w/HTN, smoking. younger w/marfan’s, ehler-danlos, pregnancy. A mortality: 75% if untreated, 15-20 if Sx. B mortality: 32-36% regardless of surgery
aortic dissection Hx
90% w/abrupt, severe pain in chest (A) or mid-back (B), “tearing” or “ripping,” dull or pressure-like, N/V + diaphoresis = common
aortic dissection: carotids
stroke
aortic dissection: spinal arteries
paraplegia
