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domingo, 3 de julio de 2016

Missed ACS

AvoidingERrors - By Jesse - July 2, 2016
"Missed ACS is a common source of medico-legal cases. In the Canadian Medical Protective Association’s 2010 articleDelay in diagnosis of ACS, they identified 292 ACS related medico-legal cases in the previous decade, and identified common problems: “incomplete history, delay in testing, incomplete testing, and misinterpretation of diagnostic tests...
  1. consider ACS, including in young patients, with chest/arm pain, SOB, tired/weak, epigastric pain/dyspepsia
  2. carefully read the ECG, including 15 lead and serial ECG
  3. consider the differential for ST changes
  4. STE = ELEVATIONS: Electrolyte (hyperK), LBBB, Early repol, Ventricular hypertrophy, Aneurysm, Thrombus (MI), Inflammation (pericarditis), Osborne waves, Non-occlusive vasospasm, Sudden death (Brugada)
  5. STD = DEPRESSED: Dilated CMO, Enlarged ventricle, Potassium loss, Reciprocal change, Embolism,Subendocardial, Shock, Encephalon bleed, Digoxin
  6. Early R-wave = R-WAVED: RBBB, WPW, ACS (posterior), Ventricle hypert (RVH), Electrode, Dystrophy
  7. T wave inversion = FLIPPED: Fascicles (BBB), LVH, Ischemia, Pulmonary embolism, Pediatric, Encephalon bleed, Digoxin"