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32505912 chest-pain-final

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Chest Pain Evaluation
Content. ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
What time of day is it?
 
How do you keep up with the stats/subset argument? ,[object Object],[object Object],[object Object],[object Object]
Common Questions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ATTACK the Clot or the Lesion?
A paradigm issue ,[object Object],[object Object],[object Object]
Acute chest pain ::::inputs
Acute chest pain ::::outcomes ,[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
ENZYMES. Most labs now only doing Troponin 1 (huge topic, Quality Control Issue). BUT not good early: - Rise at 3-6 - Peak at 14-18 - Stays for days. CAN WE USE IN ED TO SEND HOME? NO
Cases .
45yr male patient with Chest pain ,[object Object],[object Object]
At triage. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
65 yr male with chest pain. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Is this ACS? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Consider ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
If no ECG changes or N ECG what then? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Re-evaluate pts for High risk Status According to the following criteria: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
If all of the above are Negative ,[object Object],[object Object],[object Object],[object Object]
If Positive for high risk ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Why Use Low Molecular Wt Heparin (LMWH)?.
Superior outcomes with Enoxaparin ,[object Object]
LMWHs obtain antithrombotic levels within ? Time. ,[object Object],[object Object],[object Object]
What is the bioavailability of the LMWH vr UFH ,[object Object],[object Object]
 
 
65 yr female. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG shows. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
If Catherization is Normal ,[object Object],[object Object],[object Object],[object Object],[object Object]
Glycoprotein GP IIb/IIIa inhibitors ,[object Object],[object Object]
phase III-(GUSTO)-V trial ,[object Object],[object Object],[object Object]
PCI ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is the optimal approach for establishing coronary reperfusion after myocardial infarction? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alternative Strategy (NQWMI) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
34 yr male ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ECG shows. ,[object Object],[object Object],[object Object]
Treat with ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
If institutions not able to perform PCI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical evidence of reperfusion? ,[object Object],[object Object],[object Object],[object Object]
Fibrinolytic Therapy: The Current Landscape ,[object Object],[object Object],[object Object],[object Object],[object Object]
Compared to standard therapy ,[object Object],[object Object],[object Object],[object Object],[object Object]
From an outcome-effectiveness perspective ,[object Object],[object Object],[object Object]
 
Ideal fibrinolytic agent ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Candidacy for Fibrinolysis—patient Screening, Identification, and Stratification ,[object Object],[object Object]
[object Object],[object Object],[object Object]
TIMI Risk Factor Analysis ,[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]
Patient Age ,[object Object],[object Object],[object Object]
Time from Chest Pain Onset, Therapeutic Window. ,[object Object],[object Object],[object Object],[object Object]
Stroke. ,[object Object],[object Object],[object Object]
Recent Surgery and Trauma. ,[object Object],[object Object],[object Object],[object Object]
Elevated Blood Pressure. ,[object Object],[object Object]
Hypertension. ,[object Object]
[object Object],[object Object]
Cardiogenic Shock ,[object Object],[object Object]
Menstrual Bleeding ,[object Object],[object Object],[object Object]
[object Object]
The Electrocardiogram. ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object]
ST elevation “ on arrival” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Recent Cardiopulmonary Resuscitation (CPR). ,[object Object],[object Object]
Role Models.
Low Molecular Weight Heparin (Enoxaparin)— A Central Role in Fibrinolytic Regimens ,[object Object],[object Object]
[object Object],[object Object]
[object Object]
Coronary Stenting. ,[object Object],[object Object]
GP IIb/IIa Inhibitors. ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oral Platelet Antagonists— The Role of Clopidogrel Pretreatment ,[object Object]
[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Some more antiplatelet agent apart from aspirin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How do Glycoprotein IIB/IIIA work? ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
THE FORGOTTEN THERAPIES. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ST elevation “ on arrival”::PTCA ,[object Object],[object Object],[object Object],[object Object]
ST elevation “ on arrival”::PTCA ,[object Object],[object Object]
ST elevation “ on arrival”::PTCA ,[object Object],[object Object],[object Object]
NEW concept Facilitated PCI PACT trial. ,[object Object],[object Object],[object Object],[object Object]
ST elevation “ on arrival”:::: CABG ,[object Object]
ST elevation “ on arrival ,[object Object],[object Object],[object Object],[object Object]
Current practice. ,[object Object],[object Object]
 
 
 

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  • 1. Chest Pain Evaluation
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  • 4. What time of day is it?
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  • 8. ATTACK the Clot or the Lesion?
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  • 10. Acute chest pain ::::inputs
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  • 51. ENZYMES. Most labs now only doing Troponin 1 (huge topic, Quality Control Issue). BUT not good early: - Rise at 3-6 - Peak at 14-18 - Stays for days. CAN WE USE IN ED TO SEND HOME? NO
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