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List 4 problems associated with taking a medical historry in an emergency room setting 1) Busy 2) Patients are often intoxicated & aggresive 3) Long waiting times 4) May not be in a condition to give a hx e.g. unconciousness AMPLE history leading up to the presentation to critical care Allergies Medications Past medical Hx Last meal Events eading up to presentation Immediate Clinical treatment of Acute medical presentations MOANER M orphine O xygen A spirin N itrates ECG Rehydrate (IV access) What is the most common cause of myocardial ischemia Artherosclerosis Factors that increase myocardial demand SBP Ventricular volume Thickness of myocarium Heart rate Factors which reduce blood supply to myocardium Haemodynamic - resistance Cardiac - filling time, valves Haematological - O2 Sats Systemic factors - Shock ST elevation on an ECG usually indicates _____ whereas ST depression usually indicates _____ Infarction Ischemia Key characteristics which indicate differential diagnosis of MI 1. Chest pain 2. ECG changes 3. Cardiac enzyme rise Cardiac enzymes which rise in MI Troponin CK-MB Myoglobin Diaphoresis Excessive sweating Signs of heart failure Increased JVP 3rd Heart Sound Basal crepitations Pulmonary oedema Four most common complicstions of MI that lead to death 1. Decreased CO 2. Pulmonary oedema 3. Fibrillation of the heart 4. Rupture of an artery Non-modifiable risk factors leading to artherosclerosis & IHD 1. Age 2. Gender (male) 3. Genetics Potentially modifiable risk factors leading to artherosclerosis & IHD 1. Hyperlipidaemia 2. HTN 3. Smoking 4. Diabetes Causes of Cell injury and Death HOG PICNIC Hypoxia Oxidative free radicles Genetic defragments Physical agents Infection Chemicals Nutritional Immunological abnormalities CO poisoning 5 Types of Necrosis 1) Fatty - Acute pancreatitis 2) Liquifactive - Hypoxia 3) Caseous - TB infection 4) Coagulative - Hypoxic death 5) Gangrenous - ischemic limbs Arteriosclerosis is a generic thickening and stiffening of blood vessels of all sizes, due to a loss of elasticity Atherosclerosis an inflammatory disease in the intima of large and intermediate-sized arteries haracterised by intimal lesions called fibrofatty plaques Three Major Complications of artherosclerosis 1. Coronary heart disease 2. Cerebrovascular disease 3. Peripheral vascular disease What two factors does the endothelium of blood vessels release in order to make the surface antithrombotic 1. Prostocyclin 2. Nitric oxide Three broad catagories of Virchow's Triad 1. Endothelial dysfunction/injury* 2. Haemodynamic changes 3. Hypercoaguability P wave should be less than 0.12 seconds PR intervals should be less than or equal to 0.02 seconds QRS complex should be less than or equal to 0.10 seconds QT interval should be less than or equal to 0.42 seconds Large negative deflection of he P wave indicates... left atrial enlagement Prolonged PR interval indicates ... Conducting system problem Wide QRS complex indicates Delays in ventricular depolarisation e.g. bundle branch block ST elevation is an indication of... ventricular infarction ST depression is a sign of... venticular ischemia