words per minute
5
dipra989
00:00
Speed
Door time 10:45
BIBA
54yo male
C/O chest pain since this morning
Started while he was working in his garden, central crushing pain, radiating to the left side of his chest and his jaw
was associated with DIB, intense sweating, and palpitations
He does not complain of dizziness, cough or LOC
had been having similar pain but less intense and ware waxing and waning, precipitated by exertion
He mostly noted this pain while walking up hill and climbing stairs
he had recently found it difficult to lie down flat and had been using more than one pillows to sleep at night
on one occasion he was woken up in the middle of the night feeling breathless , had to get out of bed can walk around in his room before he could go back to sleep
no recent h/o fever, flu like symptoms, cough and cold, pain while taking deep breaths or moving from side to side
LAS:
Administered Asprin 300mg
GTN spray 800mcg
Morphine 5mg
PMH:
HTN
T2DM
HChol
CKD - I (baseline Cr 105)
Meds:
Amlodipine 10mg
Metformin 1g BD
Atorvastatin 20mg
Allergies:
Penicillin - Anaphylaxis
S/H:
Lives with wife and two kids
Smoker
Occasionally drinks
Worked as a software engineer
F/H:
Father had Heart attack at the age of 60
Mother had valve issues
Recent investigations:
HbA1C: 64
T Chol : 5.6
LDL: 2.4
O/E:
speaking full sentences, Sats 95% in RA
pain 8/10, dull pain now
WWP, good b/l pulses
SBP : 126
JVP not elevated
Chest: Good B/L AE, HS no murmurs, no palpable pain over precordium
Abdo: SNT
calves : SNT
LAS ECG: Anterior STEMI, with reciprocal changes in post leads
POCE: preserved LV, mild MR
Impression:
STEMI
Plan:
Admit
O2
GTN spray PRN
Morphine 5mg IV stat
Load Prasugrel 60mg stat
Cardiac monitor
Bloods: FBC, U+E, Trop, G&S
repeat 12 Lead ECG
Prepare Cathab for pPCI
IP Echo, CXR
NBO
If pain still persists, then start GTN infusion @ 2-3 ml/min and monitor BP