5 Most Common Life Threatening Chest Pain

1) Aortic Dissection
2) Pulmonary Embolism
3) Acute pericardial Effusion with temponade
4) Tension Pneumothorax
5) Myocardial Infarction.

62 years old malay lady with typical chest pain and vomiting.

62 years old Malay Lady with known case of hypertension and diabetes mellitus for 10 years under Hospital X follow up presented with severe chest pain for 1 hour prior to presentation to the casualty. The pain is centrally located, lasted about 15 minutes, Crushing in nature, not radiating and associated with one episode of vomiting.

BP: 146/78mmHg

PR: 78 b.p.m

SPO2: 98%

Glucose: 23.2 mmol/l

Urea: 6.8mmol/L

Na: 134.5 mmol/L

K: 4.6 mmol/L

Cl: 96.3 mmol/L

CKMB: 48 U/L

ECG: ST depression on lead V1 and V2

Questions

1) What is your complete diagnosis?

2) Outline your principal of management

3) What are the MOA for Beta blocker

4) What are the contraindication for Beta blocker

for answer to this questions, click [here]

Blunt Injury to the Chest

A 23 Years old Malay man was brought to hospital by the EMD after involving in MVA, car vs. car. According to the rescuer team, patient was not wearing the seatbelt. On initial assessment, the eye opened in response to pain, confused and able to localize the pain. Below is the picture of his chest.

Questions

1) Describe the picture

2) Assess this patient GCS

2) What are the injuries that likely to occur in this patient?

3) What investigation you want to take

4) How do you manage this patient?

For answer to this question, click [here]

Patient with Acute Exacerbation of Asthma who is at high risk of asthma related death

Asthma Exacerbation definition

Exacerbations of asthma (asthma attacks or acute asthma) are episodes of progressive increase in shortness of breath, cough, wheezing, or chest tightness, or some combination of these symptoms. Respiratory distress is common.[GINA Reports 2007]

High risk patient

a) History of near fatal asthma (intubated, mechanical ventilation, admission to intensive care unit)
b) Exacerbation requiring hospitalization or emergency care visit in the past year
c) Currently using or stop oral glucocorticosteroids
d) Not currently use inhaled glucocorticosteroids
e) Highly dependent on rapid acting beta 2 agonist (more than one canister of salbutamol or equivalent monthly)
f) With underlying psychiatric disease or psychosocial problems (including use of sedatives)
g) Non compliance to asthma medication plan

Reference:

Global Initiative For Asthma, "Global Strategy for Asthma Management and Prevention updated 2007", www.ginasthma.org