Sandbox Rim: Difference between revisions
Jump to navigation
Jump to search
Rim Halaby (talk | contribs) No edit summary |
Rim Halaby (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | A01 | | | | | |A01=Assess the [[ECG|<span style="color:white;">ECG</span>]]}} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | A01 | | | | | |A01=❑ '''Assess the [[ECG|<span style="color:white;">ECG</span>]]'''<br> ❑ '''Order [[troponin|<span style="color:white;">troponins</span>]]''' <br> ❑ '''Perform a bedside echocardiogrpahy (if available)'''}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | |!| | | | | | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | |!| | | | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | | | A00 | | | A00= Does the patient fulfill the criteria of myocardial infarction?}} | ||
❑ [[ST | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | |,|-|^|-|.| | }} | ||
❑ [[ST | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | A10 | | A11 | A10 = Yes | A11= No}} | ||
❑ 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;| | | | | | | | | | A12 | | A13 | | A12=Activate cath lab team <br> Treat as [[STEMI]] or [[NSTEMI]]<br> STEMI changes: ❑ [[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|<span style="color:white;">posterior MI</span>]]), '''''OR''''' <br> | |||
❑ [[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|<span style="color:white;">LAD</span>]] artery), '''''OR''''' <br> | |||
❑ New [[LBBB|<span style="color:white;">LBBB</span>]]| A13='''Does the patient have ECG changes/pericarditis? <br> ❑ Diffuse [[ST elevation|<span style="color:white;">ST elevation</span>]], '''''AND/OR'''''<br> | |||
❑ PR depression, '''''AND/OR''''' <br> | |||
❑ PR elevation in lead aVR '''}} | |||
{{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'''}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | |!| | | | | | | | | | | | | |!| | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | |!| | | | | | | | | | | | | |!| | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | |!| | | | | | | | | | | | | B04 | | B04= '''Rule out the following life-threatening conditions'''}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | |!| | | | | | | |,|-|-|-|v|-|^|-|v|-|-|-|.| | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | |!| | | | | | | C04 | | C05 | | C06 | | C07 | 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;| | | | | D04 | | | | | | D05 | | D05 | | D06 | | D07| D04=<div style="float: left; text-align: left; width: 10em; padding:1em;"> '''Look for signs and symptoms suggestive of [[Pericarditis|<span style="color:white;">Pericarditis</span>]]:''' <br> | |||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | |||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | |||
| | |||
❑ [[Pleuritic pain|<span style="color:white;">Pleuritic pain</span>]] <br> | ❑ [[Pleuritic pain|<span style="color:white;">Pleuritic pain</span>]] <br> | ||
❑ [[Chest pain|<span style="color:white;">Chest pain</span>]] that is positional <br> | ❑ [[Chest pain|<span style="color:white;">Chest pain</span>]] that is positional <br> | ||
| Line 52: | Line 26: | ||
❑ [[Cough|<span style="color:white;">Cough</span>]] <br> | ❑ [[Cough|<span style="color:white;">Cough</span>]] <br> | ||
❑ [[Pericardial rub|<span style="color:white;">Pericardial rub</span>]]</div> | ❑ [[Pericardial rub|<span style="color:white;">Pericardial rub</span>]]</div> | ||
| | | D05= <div style="float: left; text-align: left; width: 10em; padding:1em;"> '''Look for supportive signs and symptoms:''' <br> | ||
❑ Sudden onset of chest pain radiated to the back or interscapular pain<br> | ❑ Sudden onset of chest pain radiated to the back or interscapular pain<br> | ||
❑ [[Back pain|<span style="color:white;">Back pain</span>]] <br> | ❑ [[Back pain|<span style="color:white;">Back pain</span>]] <br> | ||
| Line 67: | Line 41: | ||
:❑ Lower extremity ischemia <br> | :❑ Lower extremity ischemia <br> | ||
:❑ Focal neurologic deficits </div> | :❑ Focal neurologic deficits </div> | ||
| D05= <div style="float: left; text-align: left; width: | | D05= <div style="float: left; text-align: left; width: 10em; padding:1em;"> '''Look for supportive signs and symptoms:''' <br> | ||
❑ [[Pleuritic chest pain|<span style="color:white;">Pleuritic chest pain</span>]] | ❑ [[Pleuritic chest pain|<span style="color:white;">Pleuritic chest pain</span>]] | ||
❑ [[Dyspnea|<span style="color:white;">Dyspnea</span>]] <br> | ❑ [[Dyspnea|<span style="color:white;">Dyspnea</span>]] <br> | ||
| Line 76: | Line 50: | ||
:❑ [[Malignancy|<span style="color:white;">Malignancy</span>]] | :❑ [[Malignancy|<span style="color:white;">Malignancy</span>]] | ||
:❑ Immobility</div> | :❑ Immobility</div> | ||
| D06= <div style="float: left; text-align: left; width: | | D06= <div style="float: left; text-align: left; width: 10em; padding:1em;"> '''Look for supportive signs and symptoms:''' <br> | ||
❑ Sudden [[shortness of breath|<span style="color:white;">Shortness of breath</span>]] <br> | ❑ Sudden [[shortness of breath|<span style="color:white;">Shortness of breath</span>]] <br> | ||
❑ [[Cyanosis|<span style="color:white;">Cyanosis</span>]] <br> | ❑ [[Cyanosis|<span style="color:white;">Cyanosis</span>]] <br> | ||
| Line 86: | Line 60: | ||
❑ Absent heart sound on the affected side <br> | ❑ Absent heart sound on the affected side <br> | ||
❑ Hyperresonance on the affected side </div> | ❑ Hyperresonance on the affected side </div> | ||
| D07=<div style="float: left; text-align: left; width: | | D07=<div style="float: left; text-align: left; width: 10em; padding:1em;"> '''Look for supportive signs and symptoms:''' <br> | ||
❑ [[Vomiting|<span style="color:white;">Vomiting</span>]] <br> | ❑ [[Vomiting|<span style="color:white;">Vomiting</span>]] <br> | ||
❑ Lower [[chest pain|<span style="color:white;">chest pain</span>]] <br> | ❑ Lower [[chest pain|<span style="color:white;">chest pain</span>]] <br> | ||
Revision as of 20:09, 9 March 2015
| ❑ Assess the ECG ❑ Order troponins ❑ Perform a bedside echocardiogrpahy (if available) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Does the patient fulfill the criteria of myocardial infarction? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Activate cath lab team Treat as STEMI or NSTEMI STEMI changes: ❑ 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 | Does the patient have ECG changes/pericarditis? ❑ Diffuse ST elevation, AND/OR ❑ PR depression, AND/OR | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rule out the following life-threatening conditions | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Aortic dissection | Pulmonary embolism | Tension pneumothorax | Esophageal rupture | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Look for signs and symptoms suggestive of Pericarditis: ❑ Pleuritic pain | Look for supportive signs and symptoms: ❑ Pleuritic chest pain
❑ Dyspnea
| 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 | |||||||||||||||||||||||||||||||||||||||||||||||||