Longbone and pelvis fractures do not NSAIDs bcuz of bleeding while hip fractures can get them
OPQRST assessment is very pertinent to chest pain
Epigastric pain is also related to AMIs
textbook presentation of an AMI is: Nausea, chest pain, SOB and an impending sense of doom
Chest discomfort/pain is often broad for ischemic chest pain and rarely sharp/pinpoint
If having ischemic chest pain, skin will be pale, diaphoretic and edema would be present via influx of Na+ ions
BP could be either high or low in cardiac ischemia
CCs related to MIs are: SOB, indigestion and chest/abdo/jaw/tooth pain
MI assessment framework: onset, location, duration, characteristics, associating factors, radiation and treatment/temporal factors
Onset is very pertinent to stable angina
Angina usually lasts for less than 15 minutes
If chest pain lasts for more than 30 minutes, its usually an MI; pain is also constant and not intermittent
Pleuritic/intercostal pain is typically sharp
Burning pain if shared with GI and cardiac symptoms
Associating factors refers to the provoke part of OPQRST
Causes of pleuritic pain are: Pneumonia, Pulmonary embolism, pneumothorax, pericarditis and pleuritis
Levine's sign refers to when a PT puts a fist over the primary area of pain
MEDs that should raise red flags about cardiac ischemia: beta blockers, antihypertensives, antiarrhymatics, nitrates, cardiac glycosides and lipid lowering drugs.
If suspecting cardiac ischemia, put on a 4lead and call ACPs for a 12lead
Atypical presentations of chest pain are present in: the elderly, diabetics, women and postmenopausal.
Pulmonary embolisms occur when a clot usually forms in the lower extremities and gets dislodged and travels to the right side of the heart. Clot enters the lungs and inhibits blood flow
COPD is often associated with right sided heart failure
CABG(coronary artery bypass graft): When someone has one, ask how many vessels were grafted and how many are occluded
S/S of Pulmonary embolism: hypoxia, hypoxia which results in tachypnea, may have hemoptysis and sharp pleuritic pain
Most PTs with pulmonary embolisms have SOB, tachycardia and hypoxia but all 3 may not be present
For pulmonary embolisms, inquire about DVT, sudden onset of crackles with no prior hx, recent hx of swollen arm/leg and a prior hx of pulmonary emboli
Things that could cause pulmonary embolisms: bedrest for over 24 hours, cancer, BCP(birthcontrolpill) use, blood clotting disorders, long distance travel and surgery
Stable angina is often environmental or exertional in onset
acute aortic dissection(TAAs or AAAs) cause hypertension and a difference in bilateral BPs
Ectopic beats: are weird beats expected from ischemia
PVC stands for premature ventricular contractions and looks like VTAC at some points
Do not give ASA to any PTs with a pulmonary embolism
Right sided MIs are typically associated with bradycardia and hypotension.NTG is contraindicated in these cases
Anterior/Posterior/Inferior and septal MIs are associated with tachycardia and hypertension
Left sided MIs are often caused by acutepulmonary edema
GI conditions that could cause chest pain are: GERD, Ulcers, Gallstones and pancreatitis
NTG needs pain/discomfort for administeration
For administrations of both ASA and NTG, PT must be 18 or older; they must also be unaltered
for ASA, PT must be able to chew and swallow
For NTG, normotension is required, a HR of 60-159 BPM and prior hx of NTG use or IV access obtained