GIM Question 9 Instructor

You are called to the ward at night because of an acute onset of dyspnea. Outline your initial steps.
Initial steps in management include:

  • History – onset, provoking/relieving factors, history of similar symptoms, associated symptoms (cough, sputum, hemoptysis, diaphoresis, nausea, vomiting, chest pain). Get PMHx and current inpatient care from patient chart
  • Physical exam – vitals (HR, BP, RR, O2 sat, Temp), precordial exam, respiratory exam
  • Investigations:
    • CBC, Lytes, Cr
    • ECG
    • Troponin, CK
    • Lactate (suspect sepsis or acute metabolic lactic acidosis)
    • Venous or arterial blood gas (if suspect metabolic acidosis)
    • CXR
    • CT PE (if suspect PE)
  • Supplemental O2
  • Call for help:
    • If ECG changes suggestive of Unstable Angina /NSTEMI/STEMI
    • If Pulmonary embolism
    • If unsure

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