Scribd Logo
Upload

Welcome to Scribd!

  • 21 views

    Chest Pain, ACS

    Uploaded by

    Hengkai Neo
    This document provides guidance on evaluating and managing chest pain. It notes that chest pain could be cardiac (30%) or non-cardiac (70%) in origin. Non-cardiac causes include issues with the esophagus, costochondritis, aortic dissection, and GERD. For patients at high risk, the ECG should be repeated to check for signs of ischemia. Unstable angina is classified based on the timing and severity of symptoms. Pre-hospital management includes aspirin, nitroglycerin, and an ECG. In the ED, patients are categorized based on vital signs, and treatments depend on signs of STEMI or non-STEMI on ECG and cardiac biomarker levels.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Chest Pain, ACS

    Uploaded by

    Hengkai Neo
    21 views4 pages
    This document provides guidance on evaluating and managing chest pain. It notes that chest pain could be cardiac (30%) or non-cardiac (70%) in origin. Non-cardiac causes include issues with the esophagus, costochondritis, aortic dissection, and GERD. For patients at high risk, the ECG should be repeated to check for signs of ischemia. Unstable angina is classified based on the timing and severity of symptoms. Pre-hospital management includes aspirin, nitroglycerin, and an ECG. In the ED, patients are categorized based on vital signs, and treatments depend on signs of STEMI or non-STEMI on ECG and cardiac biomarker levels.

    Original Description:

    Original Title

    Chest pain, ACS

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides guidance on evaluating and managing chest pain. It notes that chest pain could be cardiac (30%) or non-cardiac (70%) in origin. Non-cardiac causes include issues with the esophagus, costochondritis, aortic dissection, and GERD. For patients at high risk, the ECG should be repeated to check for signs of ischemia. Unstable angina is classified based on the timing and severity of symptoms. Pre-hospital management includes aspirin, nitroglycerin, and an ECG. In the ED, patients are categorized based on vital signs, and treatments depend on signs of STEMI or non-STEMI on ECG and cardiac biomarker levels.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    21 views4 pages

    Chest Pain, ACS

    Uploaded by

    Hengkai Neo
    This document provides guidance on evaluating and managing chest pain. It notes that chest pain could be cardiac (30%) or non-cardiac (70%) in origin. Non-cardiac causes include issues with the esophagus, costochondritis, aortic dissection, and GERD. For patients at high risk, the ECG should be repeated to check for signs of ischemia. Unstable angina is classified based on the timing and severity of symptoms. Pre-hospital management includes aspirin, nitroglycerin, and an ECG. In the ED, patients are categorized based on vital signs, and treatments depend on signs of STEMI or non-STEMI on ECG and cardiac biomarker levels.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    CHEST PAIN

    1. Chest pain – must say whether this is 1st episode/ No history of angina attack. DO NOT
    SAY no h/o heart diseases.

    2. Myocardial ischaemia → Seen in elderly, in uncontrolled hypertension/DM and smoker. It


    doesn’t always show a typical type of chest pain especially in female.

    3. Cardiac (30%) vs Non Cardiac (70%)

    4. Unpaired organ (heart, trachea, oesophagus, stomach, gall bladder, appendix, etc ) → Pain
    starts in the midline

    5. NOT MI:
     Localized pain and tenderness (The more likely the patient can pin point the pain,
    the more unlikely it is of cardiac origin)
     More away from the center
     1st to consider – Oesophageal causes

    6. GERD : Burning pain slightly relieved by leaning forward


    Costochondritis: At the costochondral junction near the sternum
    Aortic Dissection: Pain dominantly at upper back, can radiate to arm and abdominal pain.
    7. Obese, with DM and Hypertension, and a smoker → If the ECG is normal → Repeat the
    ECG ( 4x in 2 hours) → Insert a branula → give Aspirin

    8. Unstable angina classification:


     New onset of severe angina or accelerated angina; no rest pain
     Angina at rest within past month but not within preceding 48 hours (angina at rest,
    subacute)
     Angina at rest within 48 hours (angina at rest, acute)

    9. Pre-hospital management
     If history suggestive of ACS:
    - Give soluble aspirin 300mg
    - Give sublingual GTN (unless SBP<90 mm Hg)
    - Do 12 lead ECG & cardiac biomarkers
     If ECG & cardiac biomarkers suggestive of ACS:
    - Give clopidogrel 300mg
    - Send patient for definitive treatment
     If ECG and Cardiac biomarkers are inconclusive:
    - Low risk patient: outpatient cardiac assessment
    - Intermediate/high risk: admission

    10. 3 types of patient in ED


    1. Very low BP, very low pulse rate: complete heart block, need urgent pacemaker
    2. Low BP, pulse rate tachycardia: Left ventricular failure, cardiogenic shock
    3. BP and pulse rate acceptable

    11. Clinical features of myocardial infarction


    - Central, crushing chest pain
    - Radiates to left jaw, teeth and left arm
    - Associated with nausea, vomiting and breathlessness

    12. Once diagnosed as coronary artery disease


    - Give aspirin 300 mg, make them chew and watch them swallowing
    - Set branula
    - Give GTN
    - Do ECG : look for ST elevation :
    STEMI : Give streptokinase (ONLY STEMI GIVE)
    *Not given if chest pain >12 hours unless the pain persists or restarts
    NTSEMI ( No ST elevation, Cardiac biomarkers elevation): give Fondaparinux
    Unstable angina (No ST elevation, No Cardiac biomarkers elevation)

    13. Streptokinase : TIME= MYOCARDIUM


    Indication :
    -STEMI

    Absolute contraindication of streptokinase:


    -History of intracranial bleeding
    -History of ischemic stroke within 3 months
    -Active bleeding like peptic ulcer disease and per rectal bleeding EXCEPT Menses
    -Head trauma within 3 months

    Relative contraindication of streptokinase :


    -Uncontrolled HTN : give IV GTN
    -INR>2
    -Recent GI bleed (Active peptic ulcer)
    -Recent major surgery
    -Traumatic/ Prolong CPR >10 min

    Complications of streptokinase :
    -Bleeding : GIT, GIU
    -Hypotension
    -Allergic reaction , fever, shivering, difficulty in breathing, periorbital swelling,
    urticarial , nausea, itching
    -Anaphylatic shock

    Cardiac biomarkers : Troponin T not elevated in <6hrs (so repeat after 6 hours)

    ACLS Algorithm

    You might also like