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Complaint: sudden-onset chest pressure; weakness, syncopal episode, resolved lying down Medic response: in ED <30 minutes from pain onset Vital signs: T = 97.9F, RR = 20/min, HR = 55 to 60 bpm, BP = 75/55 mm Hg Physical exam: drenched in sweat; mild bilateral rales; no murmur
Primary ABCD: CPR/defib = not indicated Secondary ABCD: O2, IV established, lungs getting wet Medications: is MONA indicated? Differential diagnosis: a 12-lead ECG was obtained
What are the 2 most critical findings? What is the next action for you to take?
I lateral
aVR
V1 septal
V4 anterior
II inferior
aVL lateral
V2 septal
V3 anterior
V5 lateral
V6 lateral
III inferior
aVF inferior
Intervention of choice: acute angiogram and reperfusion Findings: total occlusion proximal right coronary artery and artery to SA and AV nodes (block). Rx: angioplasty, stent
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