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| {{familytree/start}} | | {{familytree/start}} |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | A01 | | | | | |A01=<div style="float: left; text-align: left; width: 25em; padding:1em;'''Therapuetic Considerations in [[RVMI]]''' | | {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | |A01= <div style="float: Center; text-align: Center; width: 20em; padding:1em;"> '''Therapuetic Considerations in [[RVMI]]'''| | | |}} |
| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | |!| | | | }} | | {{familytree | | | | | | | | | | || | |!| | | | | | | | | | | | | | |}} |
| {{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 | | | |,|-|-|-|-|v|-|-|-|-|+|-|-|-|v|-|-|-|v|-|-|-|-|.| |}} |
| ❑ Rise and/or fall of [[cardiac biomarker|<span style="color:white;">cardiac biomarker</span>]], preferably [[troponin|<span style="color:white;">troponin</span>]], with at least one of the measurements >99<sup>th</sup> percentile of the upper limit of normal<br>
| | {{familytree | | | |!| | | | |!| | | | |!| | | |!| | | |!| | | | |!| |}} |
| <br>'''''PLUS at least one of the following''''' <br><br>
| | {{familytree | | | B01 | | | B02 | | | B03 | | B04 | | B05 | | | B06 | |B01='''Reperfusion'''|B02='''Maintenance of RV preload'''|B03='''Decreased RV afterload'''|B04='''Restoring Rate/Rhythm and AV synchrony'''|B05='''Inotropic support'''|B06='''Mechanical Circulatory Support'''}} |
| ❑ Symptoms of ischemia <br> | | {{familytree | | | |!| | | | |!| | | | |!| | | |!| | | |!| | | |!| | | |}} |
| ❑ New [[ST|<span style="color:white;">ST</span>]]-T wave changes<br>
| | {{familytree | | | C01 | | | C02 | | | C03 | | C04 | | C05 | |C06 | | | |
| : ''ST-T wave changes in STEMI:'' <br>
| | |C01=<div style="float: Center; text-align: left;"> •'''Thrmobolytics''' <br> •'''Percutaneous coronary intervention (PCI)''' <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> | | |C02= <div style="float: Center; text-align: left;"> • '''Avoidance of preload reducing agents''', such as:<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> | | :❑Nitrates |
| :❑ [[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)<br><br> | | :❑Diuretics |
| | :❑Morphin |
| | • '''In patients with hypotension (without pulmonary congestion): |
| | :❑ Intravenous administration of Fluids (N/S 0.9% at 40mL for 2L, to maintain CVP <15mmHg and PCWP between 18-24 mmHg) |
| | |C03=<div style="float: Center; text-align: left;"> • '''Systemic or pulmonary vasodilators:'''<br> |
| | :❑Nitrosrusside |
| | :❑Inhaled nitric oxide<be> |
| | |C04=<div style="float: Center; text-align: left;"> • '''In patients with bradyarrhthmias:'''<br> |
| | :❑Atropine |
| | :❑Pacemaker |
| | • '''In patients with atrioventricular block:'''<br> |
| | :❑Temporary dual-chamber pacemaker |
| | |C05=<div style="float: Center; text-align: left;"> '''In patients with refractory hypotension:'''<br> |
| | :❑Dobutamine (along with fluids) |
| | :❑Other inotropes: |
| | *milrinone |
| | *norepinephrine |
| | |C06= <div style="float: Center; text-align: left;"> • '''May be needed in patients with cardiogenic shock secondary to RVMI''': |
| | :❑Direct RV support |
| | :❑Indirect RV support |
| | :❑Biventricular support}} |
| | <br><br> |
| | {{familytree/end}} |
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| : ''ST-T wave changes in NSTEMI:''
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| :❑ No changes
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| :❑ Non specific ST- T wave changes
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| :❑ [[T wave inversion|<span style="color:white;">T wave inversion</span>]]
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| :❑ [[ST depression|<span style="color:white;">ST depression</span>]] in at least 2 contiguous leads
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| ❑ New [[LBBB|<span style="color:white;">LBBB</span>]] <br>
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| ❑ New [[Q wave|<span style="color:white;">Q wave</span>]] <br>
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| ❑ New regional wall abnormality or new myocardial loss </div>}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | |,|-|^|-|.| | }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | A10 | | A11 | A10 = Yes | A11= No}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | |!| | | |!| | | }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | A12 | | A13 | | A12=<div style="float: left; text-align: left; padding:1em;">
| |
| Click here for [[STEMI resident survival guide|<span style="color:white;">STEMI resident survival guide</span>]] <br><br> Click here for [[NSTEMI resident survival guide|<span style="color:white;">NSTEMI resident survival guide</span>]] </div>| A13=<div style="float: left; text-align: center; padding:1em;">'''Rule out the following life-threatening conditions''' </div>}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | |!| | | }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | |,|-|-|-|v|-|-|-|+|-|-|-|.| | }}
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| {{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>]]'''}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | |!| | | |!| | | |!| | | |!| | }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | D04 | | D05 | | D06 | | D07| | D04= <div style="float: left; text-align: left; width: 12em; padding:1em;"> '''Look for supportive symptoms and signs:''' <br>
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| ❑ Sudden onset of chest pain radiating to the back or interscapular pain<br>
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| ❑ [[Acute heart failure|<span style="color:white;">Acute heart failure</span>]] <br>
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| ❑ [[Syncope|<span style="color:white;">Syncope</span>]] <br>
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| ❑ Low pitched early [[diastolic murmur|<span style="color:white;">diastolic murmur</span>]] best heard at the 2nd right intercostal space <br>
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| ❑ Asymmetric blood pressure in the upper extremities <br>
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| ❑ [[Coma|<span style="color:white;">Coma</span>]]<br>
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| ❑ Diminution or absence of pulse <br>
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| ❑ [[Altered mental status|<span style="color:white;">Altered mental status</span>]] <br>
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| ❑ Evidence of ischemia <br>
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| :❑ Splanchnic ischemia <br>
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| :❑ Renal insufficiency <br>
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| :❑ Lower extremity ischemia <br>
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| :❑ Focal neurologic deficits </div>
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| | D05= <div style="float: left; text-align: left; padding:1em;"> '''Look for supportive symptoms and signs:''' <br>
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| ❑ [[Pleuritic chest pain|<span style="color:white;">Pleuritic chest pain</span>]]<br>
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| ❑ [[Dyspnea|<span style="color:white;">Dyspnea</span>]] <br>
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| ❑ [[Anxiety|<span style="color:white;">Anxiety</span>]] <br>
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| ❑ History of:<br>
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| :❑ [[DVT|<span style="color:white;">DVT</span>]]
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| :❑ Recent [[surgery|<span style="color:white;">surgery</span>]]
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| :❑ [[Malignancy|<span style="color:white;">Malignancy</span>]]
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| :❑ Immobility</div>
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| | D06= <div style="float: left; text-align: left; padding:1em;"> '''Look for supportive symptoms and signs:''' <br>
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| ❑ Sudden onset of [[shortness of breath|<span style="color:white;">shortness of breath</span>]] <br>
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| ❑ [[Cyanosis|<span style="color:white;">Cyanosis</span>]] <br>
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| ❑ [[Penetrating chest wound|<span style="color:white;">Penetrating chest wound</span>]] <br>
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| ❑ Flopping sound <br>
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| ❑ Recent medical procedure <br>
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| ❑ Patient on [[mechanical ventilation|<span style="color:white;">mechanical ventilation</span>]] <br>
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| ❑ Tracheal deviation towards the unaffected side<br>
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| ❑ Absent heart sound on the affected side <br>
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| ❑ Hyperresonance on the affected side </div>
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| | D07=<div style="float: left; text-align: left; width: 12em; padding:1em;"> '''Look for supportive symptoms and signs:''' <br>
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| ❑ [[Vomiting|<span style="color:white;">Vomiting</span>]] <br>
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| ❑ Lower [[chest pain|<span style="color:white;">chest pain</span>]] <br>
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| ❑ [[Hematemesis|<span style="color:white;">Hematemesis</span>]] <br>
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| ❑ Cervical [[subcutaneous emphysema|<span style="color:white;">subcutaneous emphysema</span>]] <br>
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| ❑ Overindulgence in alcohol <br>
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| ❑ Overindulgence in food </div>}}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | |!| | | |!| | | |!| | | |!| }}
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| {{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | E04 | | E05 | | E06 | | E07 | E04= [[Aortic dissection resident survival guide|<span style="color:white;">Click here for the detailed management</span>]]| E05= [[Pulmonary embolism resident survival guide|<span style="color:white;">Click here for the detailed management</span>]]| E06= [[Tension pneumothorax resident survival guide|<span style="color:white;">Click here for the detailed management</span>]]| E07= [[Esophageal rupture resident survival guide|<span style="color:white;">Click here for the detailed management</span>]]}}
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| {{familytree/end}}
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