Go low, go slow SAQ by Michael

 
This SAQ is worth 18 marks

A 76yo man is brought to your ED by ambulance after an unconscious collapse. He describes chest pain and lightheadedness.

His initial obs are:

HR 35
BP 95/45
SaO2 100% on 10L O2 via mask
RR 20
GCS 15

His initial ECG is attached.

View attached:  Attachment 1

Question 1.
List 3 abnormalities on the ECG. (3 marks)


1. ____________________________________________________________________________________________________

2. ____________________________________________________________________________________________________

3. ____________________________________________________________________________________________________



Question 2.
List your top 3 management priorities and initial approaches. (6 marks)

Management priority      Initial Approach     
   
   
   



Question 3.
List 3 management options for his bradycardia and 1 pro and 1 con for each. (9 marks)

Management option                Pro                              Con             
     
     
     



Go low, go slow: The Answer SAQ by Michael

 
This SAQ is worth 18 marks

A 76yo man is brought to your ED by ambulance after an unconscious collapse. He describes chest pain and lightheadedness.

His initial obs are:

HR 35
BP 95/45
SaO2 100% on 10L O2 via mask
RR 20
GCS 15

His initial ECG is attached.

Question 1.
List 3 abnormalities on the ECG. (3 marks)

1. Inferior STEMI
2. Complete heart block
3. Reciprocal changes I, aVL, V2

Question 2.
List your top 3 management priorities and initial approaches. (6 marks)

Management priority      Initial Approach     
STEMI

Aspirin, dual antiplatelet, cath lab activation

Caution with GTN

CHB Consider isoprenaline, adrenaline, external pacing
Supportive care Titrate O2 (avoid hyperoxia), analgesia


Question 3.
List 3 management options for his bradycardia and 1 pro and 1 con for each. (9 marks)

 

Management option                Pro                              Con             
Atropine Quick, rapid action Unlikely to work if AV node knackered
Isoprenaline/adrenaline Titratable action May increase myocardial O2 demand
External pacing Rapid onset, works May not capture, requires sedation/analgesia
Transvenous pacing Less painful, work Needs experienced operator
PCI Fixes problem May be difficult if haemodynamically unwell