Trial SAQ exam: 'Trial' by Mat Oliver
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 |
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)
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 |