Management of the patient with acute chest pain
A 63-year-old woman presents to the ED at 2:00 a.m. complaining of nausea that began 3 hours ago. She denies any prodromal symptoms and has not had any vomiting, pain, or diarrhea. She states she and her husband had the same meal last night and that he is feeling well. She offers no other complaints. On arrival to the ED, she began vomiting.
The patient has a 10-year history of diabetes,which is treated with oral hypoglycemic medication.
In addition, she has a history of hypertension and elevated cholesterol. She quit smoking
5 years ago and drinks alcohol occasionally.
The patient’s medications ...view middle of the document...
Because the ED doesn't have access to urgent heart catheterization services, Streptokinase was started and dobutamine infusion had to commence as BP drops half way of SK.. The patient was transferred to the CCU in good condition.
As there is no urgent cath-lab facilities except in Colombo -NHSL decision to transfer largely depend on the availability of Thrombolytic agents(streptokinase)
A 59-year-old man with history of metastatic adenocarcinoma of the left lung, received 5 cycles of chemotherapy, presented to the local hospital with a complaint of 3 days of generalized weakness,chest pain and left leg swelling. His vital signs on presentation included temperature 35.8°C (96.4°F), blood pressure 140/95 mm Hg, pulse rate 126 beats/min, respiratory rate 26 breaths/min, and oxygen saturation of 93% on room air. His chest radiograph showed left side multiple opacifications compatible with previous metastetic changes and lung bases were hazy.
USs of Left leg shows large thrombus at the safeneous opening.
A computed tomography (CT) scan of the patient’s chest with intravenous contrast and bedside echocardiography were performed.
Bed side 2DECHo shows large RV with RV strain and small LV
As pre test probability was high for PE ,anticoagulation with heparin started before ct scan.
CT Scan negative for PE.
IMAGES IN EMERGENCY MEDICINE
DIAGNOSIS: Pulmonary embolism. CT evidence of pulmonary embolism with a massive clot burden consistent with saddle embolism....