Final year‎ > ‎

14.01.14 A+E thoughts

  • Don't confuse a silent chest with recovery in asthma
    • If they're clearly still breathless then give nebs (in preference to inhaler)
    • A marked wheeze may suddenly appear as they recover slightly
  • Don't be distracted by the broken bone
  • Have an extremely low threshold for investigation in chest pain
    • In the average UK ED one STEMI gets sent home every 6 months
    • Old patients may play down symptoms or have atypical pain
    • Make sure you step back and look at their symptoms objectively
      • c.f. Lady in Croydon: 80, 3 x MI risk factors, chest pain, SOB
  • Chronotropic incompetence (CI)
    • Inability of the heart to increase its rate commensurate with increased activity or demand
    • Manifests as reduced variation on 24-hour tape
    • Present in 1/3 of HF patients
  • Unusual pneumothorax presentations
    • Delayed presentation, vague symptoms
    • Pain moves around