Mx:
- Resuscitation
- Supportive Measures
- Specific Therapies
- Disposition: Who / When / Why
Be structured when answering SAQs regarding the management of a particular situation. Some conditions may not require resuscitation but it helps to consider these 4 areas in all questions.
Example: 48 year old male Inferior STEMI (meeting re-perfusion criteria)with right ventricular involvement, P 60 BP 55/30, RR 22 SaO2 99% on 2L/min. Ongoing chest pain. Outline your management.
- Resuscitation: 1L bolus Hartmanns, followed by metaraminol 0.5mg boluses as required bridging to noradrenaline infusion targeting diastolic BP > 50 to allow coronary perfusion
- Supportive Measures: Fentanyl 25mcg IV aliquots titrated to pain
- Specific Therapies: Aspirin 300mg, Ticagrelor 180mg, Heparin 5000iu IV bolus
- Disposition: Immediate referral to on-call cardiologist for activation of ‘cath lab’ and emergent PCI
Be structured in your management, but remember the worst intern!