Be structured – Management

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!

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