Sandbox Rim: Difference between revisions
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{{familytree/start}} | {{familytree/start}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; width: | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; width: 25em; padding:1em;"> | ||
❑ '''Assess the [[ECG|<span style="color:white;">ECG</span>]]'''<br> ❑ '''Order [[troponin|<span style="color:white;">troponins</span>]]''' <br> ❑ '''Perform a bedside echocardiography (if available)''' </div>}} | ❑ '''Assess the [[ECG|<span style="color:white;">ECG</span>]]'''<br> ❑ '''Order [[troponin|<span style="color:white;">troponins</span>]]''' <br> ❑ '''Perform a bedside [[echocardiography|<span style="color:white;">echocardiography</span>]] (if available)''' </div>}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | |!| | | | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | |!| | | | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | A00 | | | A00= <div style="float: left; text-align: left; width: | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | A00 | | | A00= <div style="float: left; text-align: left; width: 25em; padding:1em;">'''Does the patient fulfill the criteria of [[myocardial infarction|<span style="color:white;">myocardial infarction</span>]]?'''<br><br> | ||
❑ Rise and/or fall of [[cardiac biomarker]] (preferably [[troponin]])<br> | ❑ Rise and/or fall of [[cardiac biomarker|<span style="color:white;">cardiac biomarker</span>]] (preferably [[troponin|<span style="color:white;">troponin</span>]])<br> | ||
'''''PLUS at least of the following''''' <br> | '''''PLUS at least of the following''''' <br> | ||
❑ Symptoms of ischemia <br> | ❑ Symptoms of ischemia <br> | ||
❑ New [[ST]]-T wave changes or new [[LBBB]] <br> | ❑ New [[ST|<span style="color:white;">ST</span>]]-T wave changes or new [[LBBB|<span style="color:white;">LBBB</span>]] <br> | ||
: ''STEMI'' <br> | : ''STEMI'' <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 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> | ||
| Line 14: | Line 14: | ||
: ''NSTEMI'' | : ''NSTEMI'' | ||
:❑ [[ST depression|<span style="color:white;">ST depression</span>]] in at least 2 contiguous leads | :❑ [[ST depression|<span style="color:white;">ST depression</span>]] in at least 2 contiguous leads | ||
❑ New [[Q wave]] <br> | ❑ New [[Q wave|<span style="color:white;">Q wave</span>]] <br> | ||
❑ New regional wall abnormality or new myocardial loss </div>}} | ❑ New regional wall abnormality or new myocardial loss </div>}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | |,|-|^|-|.| | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | |,|-|^|-|.| | }} | ||
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{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | C03 | | C04 | | C05 | | C06 | | C07 | C03= '''[[Pericarditis]]''' | 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;| | C03 | | C04 | | C05 | | C06 | | C07 | C03= '''[[Pericarditis]]''' | 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;| | D04 | | D05 | | D05 | | D06 | | D07| D04=<div style="float: left; text-align: left; width: | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | D04 | | D05 | | D05 | | D06 | | D07| D04=<div style="float: left; text-align: left; width: 15em; padding:1em;"> | ||
''' | '''Look for supportive ECG changes:''' <br> ❑ 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 | ||
<br> | <br> | ||
'''Look for signs and symptoms | '''Look for supportive signs and symptoms:''' <br> | ||
❑ [[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 37: | Line 37: | ||
❑ [[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: | | D05= <div style="float: left; text-align: left; width: 15em; 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 52: | Line 52: | ||
:❑ 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: 15em; 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> | ||
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:❑ [[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: 15em; 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> | ||
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❑ 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: 15em; 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 13:10, 10 March 2015
Does the patient fulfill the criteria of myocardial infarction? ❑ Rise and/or fall of cardiac biomarker (preferably troponin)
❑ New Q wave | |||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||
| Activate cath lab team Click here for STEMI resident survival guide Click here for NSTEMI resident survival guide | Rule out the following life-threatening conditions | ||||||||||||||||||||||||||||||||||||||||
| Pericarditis | Aortic dissection | Pulmonary embolism | Tension pneumothorax | Esophageal rupture | |||||||||||||||||||||||||||||||||||||
Look for supportive ECG changes: | 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 | |||||||||||||||||||||||||||||||||||||