RISK STRATIFICATION OF PATIENTS WITH SUSPECTED AMI
Less than 30% patients currently admitted to CCU have final diagnosis AMI. Conversely 2-5% AMI patients are inadvertently sent home, accounting for 25% of all emergency care malpractice dollars awarded in litigation.
Twenty-five percent AMI patients have atypical symptoms and signs, 50% an initial non-diagnostic ECG. EDs +/- chest pain [...]
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EMERGENCY DEPARTMENT / EARLY MANAGEMENT STEMI or NSTEACS
Targeted clinical examination and 12-lead ECG within 10 minutes.
Oxygen, aspirin 75-325 mg orally (odds reduction in vascular events of 46%), nitrates S/L or IV (unless SBP < 90 mmHg, bradycardia < 50), and adequate parenteral analgesia for everyone.
Reperfusion strategy, for ST elevation or LBBB on ECG presenting within [...]
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MYOCARDIAL INFARCTION / ACUTE CORONARY SYNDROMES (ACS) - Part I
EPIDEMIOLOGY
Over 32,000 deaths per year in Australia: largest single cause.
50% reduction age-adjusted mortality (by risk-factor modification) since 1960, still falling now, but those with chronic CAD are increasing commensurately.
Still 60-70% die prehospital (this proportion unchanged) - thus overall 28-day mortality has improved little, compared with reduced [...]
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