Sandbox:Mitra: 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: 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}}


: ''ST-T wave changes in NSTEMI:''
:❑ No changes
:❑ Non specific ST- T wave changes
:❑ [[T wave inversion|<span style="color:white;">T wave inversion</span>]]
:❑ [[ST depression|<span style="color:white;">ST depression</span>]] in at least 2 contiguous leads
❑ New [[LBBB|<span style="color:white;">LBBB</span>]] <br>
❑ New [[Q wave|<span style="color:white;">Q wave</span>]] <br>
❑ New regional wall abnormality or new myocardial loss </div>}}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | |,|-|^|-|.| | }}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | A10 | | A11 | A10 = Yes | A11= No}}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | |!| | | |!| | | }}
{{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>}}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | | | | | | | | | |!| | | }}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | |,|-|-|-|v|-|-|-|+|-|-|-|.| | }}
{{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 | | D06 | | D07| | D04= <div style="float: left; text-align: left; width: 12em; padding:1em;"> '''Look for supportive symptoms and signs:''' <br>
❑ Sudden onset of chest pain radiating to the back or interscapular pain<br>
❑ [[Acute heart failure|<span style="color:white;">Acute heart failure</span>]] <br>
❑ [[Syncope|<span style="color:white;">Syncope</span>]] <br>
❑ Low pitched early [[diastolic murmur|<span style="color:white;">diastolic murmur</span>]] best heard at the 2nd right intercostal space <br>
❑ Asymmetric blood pressure in the upper extremities <br>
❑ [[Coma|<span style="color:white;">Coma</span>]]<br>
❑ Diminution or absence of pulse <br>
❑ [[Altered mental status|<span style="color:white;">Altered mental status</span>]] <br>
❑ Evidence of ischemia <br>
:❑ Splanchnic ischemia <br>
:❑ Renal insufficiency <br>
:❑ Lower extremity ischemia <br>
:❑ Focal neurologic deficits </div>
| D05= <div style="float: left; text-align: left; padding:1em;"> '''Look for supportive symptoms and signs:'''  <br>
❑ [[Pleuritic chest pain|<span style="color:white;">Pleuritic chest pain</span>]]<br>
❑ [[Dyspnea|<span style="color:white;">Dyspnea</span>]] <br>
❑ [[Anxiety|<span style="color:white;">Anxiety</span>]] <br>
❑ History of:<br>
:❑ [[DVT|<span style="color:white;">DVT</span>]]
:❑ Recent [[surgery|<span style="color:white;">surgery</span>]]
:❑ [[Malignancy|<span style="color:white;">Malignancy</span>]]
:❑ Immobility</div>
| D06= <div style="float: left; text-align: left; padding:1em;"> '''Look for supportive symptoms and signs:''' <br>
❑ Sudden onset of [[shortness of breath|<span style="color:white;">shortness of breath</span>]] <br>
❑ [[Cyanosis|<span style="color:white;">Cyanosis</span>]] <br>
❑ [[Penetrating chest wound|<span style="color:white;">Penetrating chest wound</span>]] <br>
❑ Flopping sound <br>
❑ Recent medical procedure <br>
❑ Patient on [[mechanical ventilation|<span style="color:white;">mechanical ventilation</span>]] <br>
❑ Tracheal deviation towards the unaffected side<br>
❑ Absent heart sound on the affected side <br>
❑ Hyperresonance on the affected side </div>
| D07=<div style="float: left; text-align: left; width: 12em; padding:1em;"> '''Look for supportive symptoms and signs:''' <br>
❑ [[Vomiting|<span style="color:white;">Vomiting</span>]] <br>
❑ Lower [[chest pain|<span style="color:white;">chest pain</span>]] <br>
❑ [[Hematemesis|<span style="color:white;">Hematemesis</span>]] <br>
❑ Cervical [[subcutaneous emphysema|<span style="color:white;">subcutaneous emphysema</span>]] <br>
❑ Overindulgence in alcohol <br>
❑ Overindulgence in food </div>}}
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF;| | |!| | | |!| | | |!| | | |!| }}
{{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>]]}}
{{familytree/end}}





Revision as of 15:08, 4 August 2020



 
 
 
 
 
 
 
 
 
 
 
 
Therapuetic Considerations in RVMI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Reperfusion
 
 
Maintenance of RV preload
 
 
Decreased RV afterload
 
Restoring Rate/Rhythm and AV synchrony
 
Inotropic support
 
 
Mechanical Circulatory Support
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Thrmobolytics
Percutaneous coronary intervention (PCI)
 
 
Avoidance of preload reducing agents, such as:
❑Nitrates
❑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)
 
 
Systemic or pulmonary vasodilators:
❑Nitrosrusside
❑Inhaled nitric oxide<be>
 
In patients with bradyarrhthmias:
❑Atropine
❑Pacemaker

In patients with atrioventricular block:

❑Temporary dual-chamber pacemaker
 
In patients with refractory hypotension:
❑Dobutamine (along with fluids)
❑Other inotropes:
  • milrinone
  • norepinephrine
 
May be needed in patients with cardiogenic shock secondary to RVMI:
❑Direct RV support
❑Indirect RV support
❑Biventricular support
 
 
{{{ }}}




Do's

Don'ts