- 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
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