Sandbox:Mitra: Difference between revisions

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❑ '''Order [[ECG|<span style="color:white;">ECG</span>]]'''<br> ❑ '''Order serial cardiac biomarkers ([[troponin|<span style="color:white;">troponins</span>]]) and [[CK MB|<span style="color:white;">CK MB</span>]]''' <br> ❑ '''Perform a bedside [[echocardiography|<span style="color:white;">echocardiography</span>]] (if available)''' </div>}}
❑ '''Therapuetic Considerations in [[RVMI]]
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{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | |!| | | | }}
{{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>
{{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>

Revision as of 15:49, 3 August 2020

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Therapuetic Considerations in RVMI

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Does the patient fulfill the criteria of myocardial infarction?

❑ Rise and/or fall of cardiac biomarker, preferably troponin, with at least one of the measurements >99th percentile of the upper limit of normal

PLUS at least one of the following

❑ Symptoms of ischemia
❑ New ST-T wave changes

ST-T wave changes in STEMI:
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
ST depression in several leads plus ST elevation in lead aVR (suggestive of occlusion of the left main or proximal LAD artery)

ST-T wave changes in NSTEMI:
❑ No changes
❑ Non specific ST- T wave changes
T wave inversion
ST depression in at least 2 contiguous leads

❑ New LBBB
❑ New Q wave

❑ New regional wall abnormality or new myocardial loss
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Rule out the following life-threatening conditions
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Aortic dissection
 
Pulmonary embolism
 
Tension pneumothorax
 
Esophageal rupture
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Look for supportive symptoms and signs:

❑ Sudden onset of chest pain radiating to the back or interscapular pain
Acute heart failure
Syncope
❑ Low pitched early diastolic murmur best heard at the 2nd right intercostal space
❑ Asymmetric blood pressure in the upper extremities
Coma
❑ Diminution or absence of pulse
Altered mental status
❑ Evidence of ischemia

❑ Splanchnic ischemia
❑ Renal insufficiency
❑ Lower extremity ischemia
❑ Focal neurologic deficits
 
Look for supportive symptoms and signs:

Pleuritic chest pain
Dyspnea
Anxiety
❑ History of:

DVT
❑ Recent surgery
Malignancy
❑ Immobility
 
Look for supportive symptoms and signs:

❑ Sudden onset of shortness of breath
Cyanosis
Penetrating chest wound
❑ Flopping sound
❑ Recent medical procedure
❑ Patient on mechanical ventilation
❑ Tracheal deviation towards the unaffected side
❑ Absent heart sound on the affected side

❑ Hyperresonance on the affected side
 
Look for supportive symptoms and signs:

Vomiting
❑ Lower chest pain
Hematemesis
❑ Cervical subcutaneous emphysema
❑ Overindulgence in alcohol

❑ Overindulgence in food
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Click here for the detailed management
 
Click here for the detailed management
 
Click here for the detailed management
 
Click here for the detailed management



Do's

Don'ts