Lecture

• Long bone 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 4 lead and call ACPs for a 12 lead
• 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(birth control pill) 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 acute pulmonary 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