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

      • WHY DID THEY FALL???

    • 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