By Christopher IAnson SJA Advanced Student Doctor and Training
officer (2012-13) Keeping your finger on the pulse: Heart and
Lungs
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Aims and Objectives Subjects: Chest pain ACS Angina PE MSK
Breathless Asthma COPD PE
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Causes of Chest pain Write some causes of chest pain on the
board Cardiac:Respiratory:Vascular: ACSPEAortic discetion
AnginaAsthmaAortic sheer PericarditisInfectionsSickle Cell disease
Gastric:MSK:Neurological GastritisCostocondritis Psychiatric
OesphagtitsRib # Reflux/HeartburnPulled muscle Trauma
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SOCRATES is a pain! Site Onset Character Radiation Associated
symptoms Timing (before, during, after) Exacerbating and
Alleviating factors Severity (1-10)
Clinical Features Chest Pain (crushing) Arm +/or neck pain +/or
abdominal pain SOB Cool Clammy Sense of Impending doom Nausea and
Vomiting Dizziness DEATH
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Management: ACS Monitor Ask for AED and Oxygen (give O 2 if you
can) Aspirin 300mg under tongue or chewed DO NOT SWOLLOW!!!
Ambulance HCP if available
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Angina Momentary blocking/ narrowing of arteries Clinical
Features: Chest pain Relieved by GTN and rest Similar to ACS
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Management: Angina Angina: Rest Get patient to take GTN if they
have it Monitor If 1 st episode go to hospital If GTN not relieved
treat as ACS!
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Breathlessness Causes: Asthma COPD PE Exercise Anaphylaxis
Shock Trauma
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OD PEAR Onset Duration Progression Exacerbation Association
Relieving What do you get when a pear falls from a tree? Answer:
Pear drops
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Common Presenting Complaints Cough ? Productive ?blood Wheeze
Chest pain SOB Fever/night-sweats/rigors ???Calf pain???
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Lungs: Anatomy and Physiology Airways: Trachea Bronchi
Bronchioles Alveoli Gas exchange
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Asthma Is a long term (chronic) condition characterised by and
reversible airway obstruction due to bronchospasms... Symptoms:
SOB/ increased RR Cyanosis Cough Mx: Get pt to use inhaler Sit in a
good position Oxygen if needed
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COPD Chronic disease of lungs: Bronchitis and Emphysema CF: SOB
Cough Cyanosis Mx: Same as asthma WARNING: use O 2 with
caution
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DEMO The Final Straw!
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Medicines of COPD and Asthma
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PE Blood clot in the pulmonary artery CF: Cough blood (not
always) Chest Pain SOB Neck vein distension Pain in calf Mx: Oxygen
and Hospital ASAP
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Making sure your history is AMPLE Always ask AMPLE A M P L
E