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new_img
Forum Junior Topics: 6 Posts: 39 |
A 60 year old man, smoker came to ER with excruciating chest pain for 45 min. He is knwon to have chronic heart ischemia for 2 years . PE shows profuse swetting, dispnea, galop. Vital signs: BP130/79, HR 87/min, no fever. ECG shows new elevated ST in V1, V2, V3 not present on previous ECGs. The best next step in the management of this patient is: A. order troponin, CK, GOT, LDH B. order chest xRay C. give aspirin to patient D. start thrombolisis E. order CBC
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no more a loser
| Forum Guru Topics: 140 Posts: 580
answer c
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new_img
| Forum Junior Topics: 6 Posts: 39
U are right, Aspirin is the cheapest, most benign, least invasive and so probably the best first step in the management of a patient with MI.
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Delusional
| Forum Elite Topics: 41 Posts: 226
I really don't know the degree of usefulness of this next step thing...i know i will give the patient aspirin......and since it is so easy to give i will give it str8 away and it reduces mortality and yeah good but then i will also put him on tPA and i won't delay that either .....just a a 5 minute history to exclude C/I and then he is on thrombolysis...plus by the time i finished history id almost be getting the results of his cardiac enzymes and i wld have given him some analgesic, some Beta blocker, some nitrate....etc... why do they have to make it sound like u cld throw aspirin in his mouth and stand there clapping.....hahaha Yeah well the very first thing the patient wld be getting from me wld be Aspirin whatever......I think the board should have questions that are more detailed.....show not only the very first step taken in management but also subsequent steps...like single stem but mutliple MCQ style thing Good Luck
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| Topics: Posts:
"new_img" wrote: A 60 year old man, smoker came to ER with excruciating chest pain for 45 min. He is knwon to have chronic heart ischemia for 2 years . PE shows profuse swetting, dispnea, galop. Vital signs: BP130/79, HR 87/min, no fever. ECG shows new elevated ST in V1, V2, V3 not present on previous ECGs. The best next step in the management of this patient is: A. order troponin, CK, GOT, LDH B. order chest xRay C. give aspirin to patient D. start thrombolisis E. order CBC
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Drmos
| Forum Junior Topics: 8 Posts: 41
first of all, aspirin........ :lol:
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md2besoon
| Forum Elite  Topics: 33 Posts: 228
Aspirin is a first.
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Dharam
| Forum Newbie Topics: 0 Posts: 19
WELL ; CAN ANYONE PLEASE EXPLAIN.. IN QUESTION STEM IT CLEARLY STATES ITS ST ELEVATION - MEANS INFARCT -- NOT ISCHEMIA..... AND THE NEW ONE. SO WHAT ARE WE GONNA DO TO SAVE THIS GUY; ASPIRIN? I DONT KNOW... WHAT ABOUT THROMBOLYTICS (GUIDELINE IS WITHIN 12 HOURS) THEN FOLLOW WITH HEPARIN TO PREVENT THE CLOT FORMATION. ASPIRIN WOULD BE THE ANSWER IF THE PATIENT HAD ST DEPRESSION - MEANING ISCHEMIA...
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AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
the best next treatment ASA aspirin=18% improvement of mortality Thrombolysis=greater than 50% improvement of mortality the best next step ASA it takes time to prepare the TPA even it is a one-step or two step IVP. You still need a consenus form signed, but ASA : open your month and give, make sure to tell the patient to chew Also you can give 1, 2 to 4. Means you can give a baby ASA or a 324 mg ASA. All are OK to give
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Rasul
| Forum Guru Topics: 56 Posts: 485
See, even if the pt has MI, aspirin is to be given regardless. What bothers me though is paramedics have already given that aspirin, before even putting pt in the car to bring at the hospital.Should we repeat? Board is just trying to catch us on small things, hoping that while memorizing the big staff we forget about smth very easy and small-WELL... NOT US!
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AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
Rasul, you brought up a very good point but........................ Even the patient has been on Aspirin, the prognostic variables based on the TIMI scores (TIMI scores: Thrombolysis in Myocardial Infarction scores) showed Patient who are on aspirin last week or was on aspirin actually showed poor prognosis and given 1 poor prognostic point. So it does not matter the patient is given everything by the paramedics. DO YOU KNOW OVER 50% OF ALL MI PATIENTS ARE TRANSFFERED FROM OUTLINING HOSPITALS TO UNIVERSITY CENTERS FOR CARDIAC CATH. Less than 20% of all US hospitals have a 24 hour cardiac cath. lab. Most of the MI occurred around 5, 6 7 a.m. !! (But in reality , I(my own experience) found a lot of MI occurred after exertion)
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AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
Most of the transfer of MI patients already received everything including TPA !!!!!
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AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
The NBME wants you to know the log of treatment of MI
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achilles
| Forum Guru  Topics: 90 Posts: 1222
c- give aspirin. thanks aaaaa for the explicit explanation.
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frontal
| Forum Guru  Topics: 56 Posts: 434
It's an old post you guys brought up. The folks who posted must have settled somewhere, in some college by now. I've read some posts in the match/residency forum. Those guys really have to struggle and it looks like a tough, depressing, intimidating and frustrating struggle. For some it all turns out well and worth the draining input; for the unfortunate others, it doesn't. The heavens willing, we'll all also be there someday. Good luck to all for the entire journey.
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AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
Well, even it is an old, old post, you still need to know the RULE OF ENGAGEMENT 1. Do simple things, give simple things ASA, IV fluid, check airways, intubate 2. Believe it or not. If you work in the ER, this is all you do in the next 20-30 years 3. If patient is aysmptomatic, DO NOTHING 4. If over 60, think cancer 5. Mass--->biopsy, abscess--->I & D 6. Think emergency cases, acute events you need to intervene
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frontal
| Forum Guru Topics: 56 Posts: 434
Well AAA, thank you for going on reminding us.  . Phew!
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AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
Dr. Delusional, Please respect the NMBE, MCC, UK Medical Board, EU Medical Board and the entire world. Do you know one of the best doctors in the world is called Dr. Eric Topol. Well he was fired from Cleveland Clinic back in Feb., 2006 as the Dean, Chief Academic Officer. Dr. Topol is the one who did all the TPA stuff at U of Michigan and Cleveland Clinic. After he left Cleveland Clinic , (got fired) he went to Case Reserve Western University. Dr. Eric Topol just published one of the latest paper on ASA and Plavix The multi-center world-wide research with hundred of thousands of patients showed no improvement with aspirin and Plavix use in prevention of heart attack. Dr. Eric Topol still has a 16 million dollars research grant from NIH about the mechanism of thrombosis. So you really need to appreciate why the Board asks about aspirin. Aspirin is the key to prevent thrombosis in acute coronary syndrome. Read, read, read, read, read the journals
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AAAAA
| Forum Fanatic Topics: 159 Posts: 2013
Dr. Delusional, Is it easy to publish a paper about the combination of aspirin and Plavix in prevention of heart attack in the evidence-based journal. No It took years, millions of dollars, 10 different centers and hundreds of thousands ofm hours to find out Aspirin and Plavix cause more bleeding and less efficacy in prevention of heart attack ! Aspirin story is not that simple
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