Term
| 5 urgent differential Dx for chest pain |
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Definition
1. Ischemic heart dz
2. severe aortic stenosis
3. aortic dissection
4. PE
5. spontaneous pneumothorax |
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Term
| 5 less urgent diff Dx for chest pain: |
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Definition
1. GERD
2. Muskuloskeletal pain
3. pericarditis
4. emotional/psychiatric conditions
5. pleuritis |
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Term
| HPI: what does PQRST stand for? |
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Definition
P - pallative/provocative factors
Q/A - quality/assoc Sx
R - radiation
S - severity
T - timing |
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Term
| PQRST for ischemic heart dz: |
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Definition
P - exertion, cold, stress, or spontaneous/ relieved with rest, nitro or not at all
Q/A - pressure, tightness, squeezing, heavy/dyspnea, nausea, diaphoresis, syncope, palpitations
R - left arm/jaw
S - variable
T - important info? |
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Term
| PQRST for aortic stenosis: |
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Definition
P - exertion,cold,stress,spontaneous/ rest,nitro,unrelieved
Q/A -ressure,tightness,squeezing,heavy /dyspnea,syncope,palpitations
R - left arm or jaw
S - variable
T - gradual |
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Term
| PQRST for Aortic Dissection: |
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Definition
P - none
Q/A - tearing,ripping,knife-like/ dyspnea,nausea,diaphoresis,syncope, palpitations
R - back btwn shoulder blades
S - severe
T - sudden |
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Term
|
Definition
P - none
Q/A - pleuritic/tachypnea
R - lateral to side of PE
S - severe
T - abrupt |
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Term
| PQRST for spontaneous pneumothorax: |
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Definition
P - none
Q/A - pleuritic tachypnea
R - lateral to side of pneumothorax
S - severe
T - sudden |
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Term
| 5 risk factors for atherscleotic dz: |
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Definition
1. DM
2. HTN
3. hypercholesterolemia
4. Fam Hx
5. Tobacco use |
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Term
| CC is CP what are you looking for on CXR? |
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Definition
1. pneumothorax
2. widened mediastinum
3. signs of CHF |
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Term
| what are the antiplatelet/anticoagulant therapies for acute coronary syndrome? |
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Definition
ASA asap and indefinately + heparin.
if ASA not tolerated - Clopidogrel
platelet factor antogonists should be given to high risk pts |
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Term
|
Definition
1. unstable angina
2. non-ST elevation MI (NSTEMI)
3. ST elevation MI (STEMI) |
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Term
| pt presenting w CP should have an EKG within: |
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Definition
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Term
| what are the two risk predicting scores? |
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Definition
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Term
| Pt w normal cardiac enzymes and abnormal EKG have which subtype of ACS? |
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Definition
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Term
| which of the ACS subtypes should receive immeddiate thrombolytics? |
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Definition
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Term
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Definition
| All 3 of these disease processes involve disruption of vulnerable or high-risk plaques leading to platelet activation and myocardial ischemia |
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Term
| Tx for unstable angina and NSTEMI |
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Definition
| Treatment includes aspirin, beta blockers, and enoxaparin or heparin. Once the diagnosis of NSTEMI is confirmed, a glycioprotein IIb/IIIa inhibitor should also be started with percutaneous coronary intervention (PCI) and stenting within 48 hours in selected patients |
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Term
| when the ischemia is predictable with activity and subsides with rest the pt is said to have: |
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Definition
| chronic coronary syndrome; stable angina pectoris |
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Term
| 4 indications for Non-cardiac chest pain |
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Definition
1. pain radiates to legs
2. CC is something other than CP
3. Relief w NTG doesn;t = myocardial ischemia
4. pleuritic or reproducible isn't cardiac |
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Term
| chest pain longer than __ _______ should be assoc w enzyme changes. |
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Definition
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Term
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Definition
can have ST elevation or depression
can have T wave changes esp. biphasic T waves
can be present w LBBB |
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Term
| Acute coronary syndrome algorithm: |
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Definition
ABCDEF
A- airway secure
B - breathing
C - circulation
D - drugs (O2,ASA,NO,Morphine)
E - EKG
F - fibrinolytic checklist
IV access
Labs; CMP,coag,cardiac enzymes
CXR (portable) |
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Term
| 3 indications for fibrinolytics: |
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Definition
1. Chest pain >15min <12hrs
2. STEMI or LBBB
3. Fibrinolytics NOT contraindicated |
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Term
contraindications for fibrinolytics: 9
Pneumonic: |
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Definition
DONT GIVEM
D- diff in BP >15mmHg btwn arms
O- old CNS dz
N- Noggin trauma <3mo
T- Trauma/surgery recent
G- Gestation (pregnancy)
I- Illness systemic (cancer)
V- Vitalization CPR >10min
E- Elevated BP
M- Medications (anticoags) |
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Term
| Is patient at high risk for death? 4 indications: |
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Definition
1. HR>100bmp & BP<100
2. Pulmonary edema (rales)
3. shock (cool/clamy)
4. contraindications for fibrinolytics |
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