shortness_of_breath_and_chest_pain_lecture_emergency_medicine.pptx

1. Cardiac &respiratory:

3. Life-threatening
 Acute myocardial infarction
 Angina
 Aortic dissection
 Tension pneumothorax
 Pulmonary embolism
 Oesophageal rupture

4.  Angina, stable or unstable.
 Myocardial infarction.
 Pericarditis.
 Myocarditis.
 Aortic stenosis, other valvular lesions.
 Tachyarrhythmia causing angina.
 Dissection of the aorta.

5.  Pneumonia.
 Pleurisy, less commonly an effusion.
 Pneumothorax.
 Pulmonary embolism.
 Pulmonary infarction.
 Malignancy invading the pleura.
 Sarcoidosis (rare).

6.  Myocardial infarction. Middle aged man or a
menopausal woman, obese, diabetic,
hypertensive.
 Pulmonary embolism. Bedridden patient,
already acutely ill, swelling in one leg.
 Aortic dissection. Hypertensive patient,
sudden, very severe pain.
 Pneumothorax. Young, asthmatic, on
steroids, recent chest trauma or previously
healthy.

7.  Pneumonia
 Chest wall pain
◦ Muscular
◦ Rib fractures
◦ Bony metastases
◦ Costochondritis
 Gastro-oesophageal reflux disease

10. .1
Quality of pain. Discomfort, strangling, pressure,
tightness, band, knot, weight usually signifies
cardiac pain. Heartburn and a sharp pain are less
likely to be dangerous.
.2
Location. Cardiac pain is diffuse or central and may
radiate to arms, epigastrium or jaw. Well localized
chest pain is unlikely to be of cardiac.
.3
Timing. Angina lasts for 2-5 min . An MI lasts longer
and is severe..
.4
What makes it better? Rest. Nitroglycerine.
.5
What makes it worse? Exercise, Meals. Emotion.

12.  ECG. Repeat as necessary.
 Cardiac enzymes.
 X ray chest if patient is stable and ECG is
normal. Do a portable xray
 Blood sugar
 Blood urea and creatinine, electrolytes.

18.  Progressive dyspnoea: tension
pneumothorax, treat urgently. Pass large
bore needle or cannula into upper chest to
allow air to escape from the pleural cavity.
 Give oxygen.
 Start an under water-seal drainage to allow
air to escape from the pleural cavity and
allow the lung to re-expand.
 Antibiotics, anti-TB therapy.
 Treat asthma.

35.  Wheezing?
 Asthma
 COPD
 Heart failure
 Anaphylaxis

36.  Crepitations?
 Heart failure
 Pneumonia
 Bronchiectasis
 Fibrosis

37.  Stridor?
 (Upper airway obstruction)
 Foreign body or tumour
 Acute epiglottitis
 Anaphylaxis
 Trauma, eg laryngeal fracture

38.  Crepitations?
 Heart failure
 Pneumonia
 Bronchiectasis
 Fibrosis

39.  Chest clear?
 Pulmonary embolism
 Hyperventilation
 Metabolic acidosis, eg diabetic ketoacidosis
(DKA)
 Anaemia
 Drugs, eg salicylates