Professional Documents
Culture Documents
By Faraz Hussain
-Hx -O/e -DDx -Ix -Mx of common conditions Common OSCE stations Quiz
Hx
CHEST PAIN
Collapse/syncope
O:Sudden
C: Crushing, heavy R: Neck/jaw, L arm
PMH
IHD
DM
HTN Hypercholesterolaemia
Renal disease
Smoking, ETOH FH
O/e
Intro & consent:
PALLOR
SCARS PERIPHERAL OEDEMA (press on leg)
Inspection: Hands
Nails: Clubbing Nicotine/tar staining Splinter haemorrhages Pulse: Rate Rhythm Collapsing pulse BP
Palpation
Apex beat
Heaves/thrills
Auscultation
Mitral area PSM+R to axilla = MR
Tricuspid area
Aortic area ESM + R to carotids = AS Pulmonary area
Back:
Scars
Sacral oedema
Lung bases
Complete Ex
Cover and thank pt
ACS
Pneumonia
Reflux
Rib #
Aortic dissection
PE
Costochondritis
Pericarditis
Pneumothorax
DDx SOB
Cardiac Heart failure Arrhythmia Respiratory Pneumonia Pneumothorax PE Exac. Asthma/COPD Chronic Fibrosis, bronchiectasis, Lung Ca Chronic Anaemia Anxiety
DDx Collapse
Cardiac Neuro Other
Arrythmia
Stroke
Vasovagal
MI
Seizure
Hypoglycaemia
Syncope
Mechanical fall
Ix
Urine & Cultures Bloods Imaging Scopic/biopsy Functional Haematuria, blood cultures FBC, U&Es, LFTs, CRP, TFTs, ABG CXR, ECHO Angiography ECG
5 minute break
Management
ABCDE, resuscitate and stabilise
Stable Angina
Conservative Smoking cessation, exercise, diet modify, wt loss GTN, Aspirin, atenolol, statin Angioplasty, CABG
Medical Interventional/surgical
ACS
Unstable Angina Trop -ve
NSTEMI
STEMI STEMI MONA + PCI
Trop +ve
Trop +ve AND ST-elevation O2, ABCD resus + stabilise GTN 2 sprays Aspirin 300mg Morphine 5-10mg + metoclopramide 10mg PCI/thrombolysis Transfer to CCU O2, ABCD resus + stabilise GTN 2 sprays Aspirin 300mg Clopidogrel 300mg + LMWH (enoxaparin) Transfer to CCU
Tachyarrhythmias
Bradyarrythmias
Pulse < 60bpm, HR<40 dangerous as can result in asystole
CARDIAC IHD affecting SA/AV node Fibrosis of nodal tissue in elderly NON-CARDIAC Iatrogenic: Beta-blockers, digoxin Metabolic: hypothyroidsim, hypothermia
Brady Mx
ABCDE, resus & stabilize
-Heart failure -Hypotension -Reduced GCS -Chest pain Asymptomatic >40HR then monitor If not then get Help Atropine 0.5mg IV Pacing (DC cardiovert)
AF
Definition:
Chaotic, irregular SVT. The SA node has disorganised electrical impulses with the AV node responding intermittently hence an irregularly irregular ventricular rate
Aetiology
Cardiac
MI Valvular disease Heart failure
Non-cardiac
Pneumonia Thyrotoxicosis Alcohol/electrolyte abnormalities (Mg,K)
AF Mx
ABCDE, resus & stabilise
MR
Prosthetic valve Pacemaker
AF
Quiz
Bleeped by nurse to r/v pt with high MEWS
DDx
Ix Mx
Conclusion
Chest pain
Questions