![]() ![]() ST elevation on a 12-lead ECG and positive troponin blood chemistry indicate a medical emergency.Īlthough EDs are the first to receive patients with MI, some may occur after admission. Type 5: MI associated with cardiac surgeryįor the purposes of this review, we’ll focus on Type 1 MI (ST-segment elevation MI ), which is caused by atherosclerotic plaque rupture, ulceration, fissure, or erosion leading to intraluminal thrombus formation and obstructed coronary blood flow. Type 4: MI associated with percutaneous coronary intervention (Type 4a) or stent thrombosis (Type 4b) Type 3: Sudden unexpected cardiac death with symptoms that suggest myocardial ischemia Type 2: MI secondary to ischemia caused by either oxygen demand or decreased supply Type 1: Spontaneous MI related to ischemia caused by a primary coronary event (for example, plaque erosion or rupture, fissuring, or dissection) The five types of myocardial infarction (MI) are: Low’s room to retrieve an antacid to treat indigestion. Low’s chart and finds that he’s been a smoker for 55 years and has a history of heart failure. Low rates his pain as 6 and tells Sam that he had a similar episode the previous week, but that he didn’t go to the ED. Low if this is how he felt in the emergency department (ED) and then asks him to rate his pain on a 1 to 10 scale. Low’s lungs are clear at the apex and diminished in the bases. Low’s blood pressure (BP) is 135/75 mmHG and his heart rate (HR) is 88 beats per minute (bpm). Sam’s focused cardiac assessment indicates that Mr. Low is diaphoretic and short of breath, his respiratory rate (RR) has increased from 12 (when he was admitted) to 22 breaths per minute, and his O 2 saturation is 95% on room air. Low sitting up in bed and holding his hand to the center of his chest. The evening nurse, Sam Cordone, finds Mr. After dinner he experiences chest pain and pushes his call button. Henry Low*, age 75, is admitted to a monitored unit with indigestion-related chest pain. Focused chest pain assessment, 12-lead ECG performance, emergent administration of loading medications such as aspirin, and an anti-platelet agent are imperative to the survival of heart muscle and patient lives.Rapid nurse identification of myocardial infarction in medical surgical patients is key to achieving lifesaving treatment in the heart catheterization lab.Author Guidelines and Manuscript Submissionįocused assessment can aid quick diagnosis and treatment.Often accompanied by reduced hepatic and cardiac dullness on percussion, a widened / flared costal angle, and Hoover's sign. the fingers get "squeezed" as the sternum rises with inspiration). In a patient with severe hyperinflation, the crico-sternal distance is much shorter (because the sternum is elevated), maybe 1-2 fingers at most. With inspiration one's fingers get "squeezed" out as the already "high" sternum rises up to the level of the cricoid, thus, in many cases, obliterating the crico-sternal distance altogether. Some clinicians label this sign "tracheal shortening" but strictly speaking, the actual tracheal length does not get shorter. Classically this is seen with severe emphysema / hyperinflation, or severe air trapping. As the person breathes in, the space may reduce to two fingers at most (i.e. Clinical Pearl Insert (in a normal individual) three fingers vertically in the space under the cricoid cartilage, and above the sternal notch. Peadar Noone trained in Galway, Dublin, Boston, the UK and Chapel Hill, where he is now Associate Professor of Medicine and Medical Director of the Lung Transplant Program at the University of North Carolina, Chapel Hill. Look for signs of volume loss (or gain) on the side that moves less(hollow supraclavicular fossae, intercostal spaces prominent, shoulder droopy, scapula outline more prominent).ĭr. REMEMBER : "The side that moves less, is the side of disease!" Harrison's sulcus: a horizontal grove where the diaphragm attaches to the ribs associated with chronic asthma, COPD, & Rickets.When the diaphragms are flattened (as in COPD), inhalation paradoxically causes the angle to decrease. Normally, during inhalation the chest expands laterally, increasing this angle. ![]() The "subcostal angle" is the angle between the xiphoid process and the right or let costal margin.Hoover's sign: briefly, during inspiration a paradoxical medial movement of the chest.Dahl Sign: Above the knee, patches of hyperpigmentation or bruising caused by constant 'tenting' position of hands or elbows.Prominent angle of Louis (or sternal angle).Normal in infancy and increased with aging.Pursed lips on exhalation (provides a small amount of PEEP). ![]()
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