Sandbox Rim: Difference between revisions
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{{familytree/start}} | {{familytree/start}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | A01 | | | | | |A01=Assess the ECG}} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | A01 | | | | | |A01=Assess the [[ECG|<span style="color:white;">ECG</span>]]}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | |!| | | | | | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | |!| | | | | | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | A02 | | | | | A02= '''Does the patient have ANY of the following?''' <br> | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | A02 | | | | | A02= '''Does the patient have ANY of the following?''' <br> | ||
❑ [[ST elevation]] <br> | ❑ [[ST elevation|<span style="color:white;">ST elevation</span>]] <br> | ||
❑ [[ST depression]]<br> | ❑ [[ST interval#ST Depression|<span style="color:white;">ST depression</span>]]<br> | ||
❑ New [[LBBB]] | ❑ New [[LBBB|<span style="color:white;">LBBB</span>]]}} | ||
}} | |||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | B01 | | | | | | | | | | | | B02 |B01='''Yes'''|B02='''No'''}} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | B01 | | | | | | | | | | | | B02 |B01='''Yes'''|B02='''No'''}} | ||
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{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| |,|-|-|-|+|-|-|-|.| | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| C01 | | C02 | | C03 | | |!| | | |!| | | |!| | | |!| | C01= | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| C01 | | C02 | | C03 | | |!| | | |!| | | |!| | | |!| | C01= | ||
❑ ST elevation in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads <br> | ❑ [[ST elevation|<span style="color:white;">ST elevation</span>]] in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads, '''''OR''''' <br> | ||
❑ [[ST interval#ST Depression|<span style="color:white;">ST depression</span>]] in at least two precordial leads V1-V4 (suggestive of posterior MI), '''''OR''''' <br> | |||
❑ [[ST interval#ST Depression|<span style="color:white;">ST depression</span>]] in several leads plus [[ST elevation|<span style="color:white;">ST elevation</span>]] in lead aVR (suggestive of occlusion of the left main or proximal LAD artery), '''''OR''''' <br> | |||
❑ New [[LBBB|<span style="color:white;">LBBB</span>]]<br> | |||
OR<br> | |||
❑ New [[LBBB]] <br> | |||
'''''AND'''''<br> | '''''AND'''''<br> | ||
❑ PR depression is absent | ❑ PR depression is absent</div> | ||
| C02= ❑ ST depression in at least two precordial leads that fits the anatomic distribution of a coronary artery (not V1 through V4) | | C02= ❑ ST depression in at least two precordial leads that fits the anatomic distribution of a coronary artery (not V1 through V4) | ||
| C03= ❑ Diffuse ST elevation, '''''AND/OR'''''<br> | | C03= ❑ Diffuse [[ST elevation|<span style="color:white;">ST elevation</span>]], '''''AND/OR'''''<br> | ||
❑ PR depression, '''''AND/OR''''' <br> | ❑ PR depression, '''''AND/OR''''' <br> | ||
❑ PR elevation in lead aVR}} | ❑ PR elevation in lead aVR}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | C01= '''[[STEMI]]'''| C02= '''[[ | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | C01= C01= '''[[STEMI|<span style="color:white;">STEMI</span>]]'''| C02= '''[[Pericarditis|<span style="color:white;">Pericarditis</span>]]''' | C03= '''[[Unstable angina|<span style="color:white;">Unstable angina</span>]]/[[NSTEMI|<span style="color:white;">NSTEMI</span>]]''' | C04= '''[[Aortic dissection|<span style="color:white;">Aortic dissection</span>]]''' | C05= '''[[Pulmonary embolism|<span style="color:white;">Pulmonary embolism</span>]]'''| C06= '''[[Tension pneumothorax|<span style="color:white;">Tension pneumothorax</span>]]'''| C07= '''[[Esophageal rupture|<span style="color:white;">Esophageal rupture</span>]]'''}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| |!| | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | ||
| D01= <div style="float: left; text-align: left; width: 12em; padding:1em;"> | | D01= <div style="float: left; text-align: left; width: 12em; padding:1em;"> | ||
'''Activate the cath lab | '''Activate the [[cath lab|<span style="color:white;">cath lab</span>]] team''' <br><br>'''Look for supportive signs and symptoms while the [[cath lab|<span style="color:white;">cath lab</span>]] team is mobilized:''' <br> | ||
<br><br> | |||
'''Look for supportive signs and symptoms:''' <br> | |||
❑ Pain described as a heaviness or crushing sensation <br> | ❑ Pain described as a heaviness or crushing sensation <br> | ||
❑ Pain radiating to the left arm <br> | ❑ Pain radiating to the left arm <br> | ||
Line 43: | Line 37: | ||
❑ High [[CK MB]] </div> | ❑ High [[CK MB]] </div> | ||
|D02= <div style="float: left; text-align: left; width: 12em; padding:1em;"> | |D02= <div style="float: left; text-align: left; width: 12em; padding:1em;"> | ||
'''Activate the cath lab | '''Activate the [[cath lab|<span style="color:white;">cath lab</span>]] team''' <br><br>'''Look for supportive signs and symptoms while the [[cath lab|<span style="color:white;">cath lab</span>]] team is mobilized:''' <br> | ||
<br><br> | |||
'''Look for supportive signs and symptoms:''' <br> | |||
❑ Pain described as a heaviness or crushing sensation <br> | ❑ Pain described as a heaviness or crushing sensation <br> | ||
❑ Pain radiating to the left arm <br> | ❑ Pain radiating to the left arm <br> |
Revision as of 17:00, 9 March 2015
Assess the ECG | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Does the patient have ANY of the following? ❑ ST elevation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Does the patient have any of the following? | Rule out the following life-threatening conditions | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
❑ ST elevation in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads, OR ❑ ST depression in at least two precordial leads V1-V4 (suggestive of posterior MI), OR AND | ❑ ST depression in at least two precordial leads that fits the anatomic distribution of a coronary artery (not V1 through V4) | ❑ Diffuse ST elevation, AND/OR ❑ PR depression, AND/OR | |||||||||||||||||||||||||||||||||||||||||||||||||||||
C01= STEMI | Pericarditis | Unstable angina/NSTEMI | Aortic dissection | Pulmonary embolism | Tension pneumothorax | Esophageal rupture | |||||||||||||||||||||||||||||||||||||||||||||||||
Look for supportive signs and symptoms: ❑ Pleuritic pain | Look for supportive signs and symptoms: ❑ Sudden onset of chest pain radiated to the back or interscapular pain
| Look for supportive signs and symptoms: ❑ Pleuritic chest pain
❑ Dyspnea
| Look for supportive signs and symptoms: ❑ Sudden shortness of breath | Look for supportive signs and symptoms: ❑ Vomiting | |||||||||||||||||||||||||||||||||||||||||||||||||||
Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | Click here for the detailed management | |||||||||||||||||||||||||||||||||||||||||||||||||