dr.roh
Forum Guru
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Posts: 361
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1)pt. in ER without Focal Neuro. signs
1st Ct-scan without IV contrast
2nd ASA, Heparin
3rdCarotid Duplex scan
4th If Stenosis < 50%---than long term medical TX--ASA +/- Clopidogrel
*IF stenosis > 70%---TX CEA (stenosis 50-70%--management controversial)
2) Pt. comes to ER with Focal Neuro. Signs
*should be managed as having stroke----
1st-thrombolytics given within 3hrs.
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Not sure 
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| Justice
Forum Fanatic
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Posts: 2,324
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I guess the main point here is that this Pt has MI/fibrillation (see palpitations in the Pts), and this is known to be a one of the major causes of tromboembolic TIA... So, I chose EKG...
In addition, TIA and hemorrhagic stroke have different dynamics... TIA has acute presentation whereas hemorrhagic one would progress slowly...
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| dr.roh
Forum Guru
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ok so my 3rd step can be DO carotid duplex scan (if elderly pt. with carotid bruits)
OR
3rd--do Echo. (cardiac source in younger pt....if can't find anything---than it might be Factor V Leiden Mutation problem)
OR
3rd if Signs of Atrial Fribillation---DO Holter Monitor
Or
like you said if MI source than do EKG
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| dr.roh
Forum Guru
Topics: 159
Posts: 361
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OK got you  ....I just re-read the question.....it said chest pain....
Conrad always said the first step for anyone presenting with chest pain
IS EKG
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I guess my sequence would work...if chest pain wasnt mentioned
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