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Jamie Ranse Registered Nurse Emergency Department The Canberra Hospital Chest Pain: Nursing Assessment and Management

Overview:

Overview Causes of chest pain Risk factors Chain of Survival Prioritising / Triage Assessment Nursing Management Medical Management Conclusion Questions

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Pneumothorax Myocardial Infarction Respiratory Infection Angina Musculoskeletal Pericarditis Aortic Dissection Trauma Anxiety Pulmonary Embolism Oesophageal Reflux / Spasm Causes

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Case 1: 40 year old man 2 hours central chest pain Radiating to (L) arm Pale, cold, clammy Case 2: 55 year old woman 1 hour generalised weakness and unwell Discomfort in throat Who is having an MI?

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Diabetes High Blood Pressure Physical Inactivity Over 40 Vascular Disease High Cholesterol Previous MI Obesity Smoking Family History Unhealthy Dietary Habits Risk Factors

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Early Recognition and Assessment Early Access Early CPR Early Defibrillation Early Advanced Cardiac Life Support Chain of Survival

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Case 1: 40 year old man 2 hours central chest pain Radiating to (L) arm Pale, cold, clammy Triage: Rapid Assessment Prioritise Injury / Illness Allocate Triage Category Scenario

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Primary Assessment A – clear and open B – spontaneous, AE R=L o added sounds C – tachycardic - weak, diaphoretic D – GCS 15, PEARL, full ROM / Strength / Sensation all limbs Secondary Assessment E – Change into patient gown F – Observations: R: 28, P: 120, BP: 149/66, T: 37 2 , (monitor) BSL: 6.9, Pain 5/10, SpO 2 99% RA G – Comfort measures H – Detailed history / Family History / heat-to-toe assessment Time = Muscle Assessment

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lleregies A M P L E edications revious medical, surgical and family history ast meal vents Assessment

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osition: Where is the Pain? P Q R S T A A A uality: What does the pain feel like? [sharp, dull, burning] adiation: Does the pain move anywhere? everity: Rate the pain on a scale between 0 and 10 iming: When did the pain start? Is it continuous? lleviating factors: What makes it better? ggravating factors: What makes it worse? ssociated symptoms: e.g., nausea / pins and needles Assessment

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Inspect Palpate Percussion Auscultation Assessment

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Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow Notify Nursing Team Leader and Senior Doctor Primary B – Supplementary Oxygen C – ECG Nursing Intervention

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Nursing Intervention

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Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow Notify Nursing Team Leader and Senior Doctor Primary B – Supplementary Oxygen C – ECG IVC 18g Bloods to pathology (FBC, UEC, CP, CK, Troponin, ABG) Secondary F – Observations G – Analgesia / Medications Reassurance, bed rest, patient and family education Nursing Intervention

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Interpretation of ECG Chest X-Ray IVC  bloods to pathology Medications Anginine Aspirin Morphine GTN infusion Clopidogrel Heparin Cardiology Review Treatment Options PTCA Thrombolysis Medical Intervention

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Percutaneous Transluminal Coronary Angioplasty Examine coronary arteries Dilate coronary arteries “Gold standard” PTCA

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PTCA

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Unsuccessful stenting (<10%) Inability to advance the wire Re-closure Vessel recoil Pain Arrhythmia Coronary spasm Haemorrhage PTCA: Complications

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Indications for use When PTCA unavailable 25% - 40% to achieve normal blood flow Complications Major bleeding Thrombolytics

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Causes of Chest Pain Risk Factors Chain of Survival Assessment / Recognition Bias Assessment Nursing Interventions Medical Management PTCA v Thrombolytics Conclusion

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Questions