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Flashcards in EM Basic Chest Pain Deck (16):
1

What is the mnemonic for 6 deadly causes of chest pain?

PET MAC
PE
Esophageal rupture
Tension Pnemo
MI
Aortic Dissection
Cardiac Tamponade

2

What is the workup for for pts w/chest pain?

EKG - screens for CAD, arrhythmia
CXR - pneumo, dissection, esophageal rupture

3

What gives an immediate ticket to CATH lab?

Chest pain + STE 2mm or > in 2 contiguous leads

4

Young thin smoker w/sudden onset of chest pain look for what?

Spontaneous pneumothorax

5

Esophageal rupture - how to rule out?

CXR - free air under diaphragm
Peritonitis on ABD exam
Hx of forceful vomiting - alcoholic?
Recent endoscopy

6

Dissection - how to r/o?

HTN hx, pregnancy, CT diseases
Unequal BPs (> 20)

7

Chest pain + motor/Neuro think of what?

Dissection

8

What is an atypical presentation for females w/MI?

Fatigue, weak, Nausea, Diabetic

9

What labs to order for MI?

EKG
CXR
CBC - anemia?
Chem10 - electrolyte abnormalities
Coags - want baseline set
Cardiac enzymes - troponin elevates in first 4-6 hours, CK 6-8

10

R/o MI give what for treatment?

325mg ASA
Nitroglycerin 0.4 mg sublingual q5 min x 3 doses, HOLD if systolic < 100 or no chest pain, if they pass out give them 500mL NS bolus
If still in Pain: 4 mg IV Morphine + 8mg Zofran
Repeat EKG before admit

11

What is the basic w/u for PE?

EKG
CXR - maybe PA lateral
CBC
Chem10 - Cr for CT
Coags - baseline needed

12

What is the PERC rule?

BREATHS mnemonic

Low risk for PE, no CTA needed
BREATHS
Blood in sputum
RA sat < 95%
Estrogen/OCP
Age > 50
Thrombosis in PMHx
HR > 100
Surgery in last 4 weeks

13

When should you get a d-dimer?

PERC +, usually bc of HR or OCPs

14

How to treat PE w/no vital signs change?

If no hemodynamically unstable?

1 mg/kg Lovenox subQ or Heparin and order Cardiac enzymes, BNP

Thrombolytics

15

PE w/u need what?

EKG
CXR
CBC
Chem10
Coags
Risk Stratify - Med/High —> Get CTA chest

16

What is the Sgarbossa criteria (3)?

STE >/= 1 mm w/concordant QRS complex (#1 indicator of acute MI) Ex. + QRS and + T wave and J point
STE >/= 5 mm where discordant w/QRS
ST depression >/= 1 mm in lead V1, V2, V3 —> look at J point