The following conditions are considered as medical emergencies. An early diagnosis and prompt management are often life saving in these disease conditions. Senior physician(s) must be informed and consulted whenever such medical emergencies are encountered.
1. Shock
2. Acute coronary syndrome
3....
The following conditions are considered as medical emergencies. An early diagnosis and prompt
management are often life saving in these disease conditions. Senior physician(s) must be
informed and consulted whenever such medical emergencies are encountered.
1. Shock
2. Acute coronary syndrome
3. Acute left ventricular failure
4. Hypertensive encephalopathy
5. Acute respiratory failure
6. Acute severe asthma
7. Acute exacerbation of COPD
8. Tension pneumothorax
9. Acute kidney injury
10. Hypokalemia, hyperkalemia, hypocalcemia
11. Diabetic emergencies [Hypoglycemia, DKA & HHS]
12. Adrenal crisis
13. Acute upper gastrointestinal hemorrhage
14. Hepatic encephalopathy
15. Acute abdomen
16. Unconscious patient
17. Status epilepticus
18. Stroke [Infarction, intracerebral hemorrhage, subarachnoid hemorrhage]
19. Meningitis
20. Encephalitis
21. Severe malaria
22. Dengue hemorrhagic fever
23. Septicemia
ROUTINE INVESTIGATIONS FOR HOSPITAL ADMITTED PATIENTS
The following investigations should be done in all hospital admitted patients, even when clinical
features are not suggestive of a related disease, as they often detect major illnesses in
asymptomatic people and they have important role in management plan:
1. Complete blood count
2. Random blood glucose
3. Serum creatinine
4. SGPT
5. Serum electrolytes
6. Urine routine & microscopic examination
7. Chest X-ray
8. ECG
, CENTRAL CHEST PAIN
CLINICAL EVALUATION
Diagnosis History Clinical examination
1. Acute coronary Sudden severe pain Brady/tachycardia
syndrome Radiation to neck, jaw , upper limb Irregular pulse
Vomiting Hyper/hypotension/shock
Sweating
Risk factors : Smoking, hypertension,
diabetes
2. Stable angina Pain on exertion
Relieved with rest
Radiation to neck, jaw, upper limb
Risk factors : Smoking, hypertension,
diabetes
3. Pericarditis Fever Pericardial rub
Risk factors : Tuberculosis, CKD
4. GERD Burning sensation in chest and neck
Worse with lying down
5. Costochondritis Aggravates with movement Local tenderness
6. Psychogenic chest Associated with bizarre unrelated
pain symptoms
Psychological stress
FIRST LINE INVESTIGATIONS
1. ECG ST elevation with convexity upwards Acute coronary syndrome
T inversion (Acute MI or unstable angina)
Pathological Q wave
ST elevation with concavity upwards Pericarditis
2. Serum Troponin T or I Elevated Acute myocardial infarction
EMERGENCY MANAGEMENT
Acute coronary syndrome Emergency treatment
IV access
High flow oxygen : 5-6 liter/min
Antiplatelet : (Aspirin 75 mg + Clopidigrel 75 mg) 4 tab
Ondansetron 8 mg, 1 ampoule IV
Morphine 15 mg, 1 ampoule with 14 ml normal saline, 5 ml IV every
10 minutes
Fibrinolysis : Streptokinase 1.5 million units, 1vial in 45 ml normal
saline or 5% dextrose in aqua, IV @ 10 drops/min in ST elevated
acute MI (To be decided by senior physician).
Urgent consultation with CARDIOLOGIST.
Subsequent treatment
Antiplatelet: : (Aspirin 75 mg + Clopidigrel 75 mg) 1 tab daly
Beta blocker : Carvedilol 6.25 mg, ½ tab 12 hourly
ACE inhibitor : Ramipril 2.5 mg, 1 tab 12 hourly
Statin : Atorvastatin 10 mg, 1 tab daily
Pericarditis Paracetamol SR 665 mg, 1 tab 8 hourly for 1 week
GERD Proton pump inhibitor : Esomeprazole 40mg, 1 tab daily for 2 weeks
Costochondritis Paracetamol SR 665 mg, 1 tab 8 hourly for 1 week
Psychogenic chest pain Reassurance and counseling
Anxiolytic : Bromazepam 3 mg, 1 tab daily for 1 week
Consultation with PSYCHIATRIST.
PERIPHERAL CHEST PAIN
CLINICAL EVALUATION
Diagnosis History Clinical examination
Pneumonia Short history Chest
High fever Dullness
Purulent sputum Bronchial breath sound
Increased vocal resonance
Crepitations
Central cyanosis
Lung abscess Short history Chest
High fever Dullness
Purulent sputum Bronchial breath sound
Increased vocal resonance
Crepitations
Clubbing
Tuberculosis Long history Chest
Low grade fever, evening rise Crepitations
Weight loss
Cough with hemoptysis
Bronchial carcinoma Long history Chest
Elderly Dullness
Cough with emoptysis Reduced breath sound
Weight loss Reduced vocal resonance
Clubbing
Pneumothorax Short history Chest
, Severe sharp pain Hyperresonance
Dyspnea Reduced breath sound
Reduced vocal resonance
Central cyanosis
Costochondritis Pain aggravated by movement Local tenderness
Herpetic neuralgia Burning pain Hyperalgesia and vesicles along der-
Along dermatome matome
Psychogenic chest pain Associated with bizarre unrelated
symptoms
Psychological stress
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