pbl 4

PBL 4

"A fibrillating Heart"

---------------------Part1-------------------------

keywords

55 year old

man

watching morning news

constricting chest pain

breathless

cold sweat

pain persist

hospitalized

ECG

vital signs

cardiac enzymes

suggesting...?

Angina pectoris?

stable angina

looking for Q-wave, ST-elevation, QRS axis

Vital signs - pulse rhythm

Cardiac enzymes - troponin?

hypothesis

the man has chest pain breathlessness and cold sweat. further investigation needed.

murmurs?

echocardiogram?

take history

history of previous attacks?

did he do anything to help his pain?

on any medication?

any emotional distress?

respiratory system review?

aortic dissection?

muscle pain?

coastal chondritis

cardiac tamponade - from trauma

cancer of lung, breast

refine thinking process

--------------------part 2-------------------------

keywords

Raised ST

pathological Q waves in 2,3, and aVF

plasma cardiac enzyme raised

treatment given

CCU Coronary care Unit

next day

lost consciousness

no breathing

pulseless

ECG -

------------------------

suggesting...?

raised ST suggesting MI

2,3, aVF - more towards ventricles

what cardiac enzymes?

what treatment?

what caused the change?

loss of consciousness due to loss of purfusion - pulseless

ECG monitor - ventricular fibrillation.

torsade de pointes?

------------------------

we want to know;

was he on medication before?

what kind of treatment?

what kinds of PCEs?

how is he kept alive?

what caused the change?

hypothesis - acute MI leading to ventricular fibrillation. (complication)

-------------part3--------------------------

keywords

ECG - ventricular fibrillation

CPR

2 shocks of defrib

normal sinus rhythm restored.

other advanced facilities.

----------------

learning issues

"other advanced life support facilities"

up=to-date management of MI

managements of fibrillation

type of MI

CPR and defib types and procedures

Plasma cardiac enzyme types

MI to ventricular fib - patho physiology

complication of MI

MI and ECG

other causes of chest pains

epidemiology of MI

risk factors of MI

drug choice for MI

CCU

concept behind Defribllation

other surgical option - should there be any

cardiac arrest - causes consequences and management

ES- councelling for patients

com med - coronary awareness

MI pathophysiology of pain, remodelling and enzyme release

"why do we feel so much pain in the heart?"

where else are the enzymes detected.

which, when the cardiac enzymes are released how

at which point do we consider Acute Immergency angioplasty or catherisation

understand the protocol of management of ACS