A 67 year old male presents to your urban district emergency department 1 hour post onset of chest pain. His ECG reveals acute ST segment elevation of 3mm in leads V3, V4 and V5. He is treated with aspirin (300mg), reteplase (two 10 unit boluses 30 minutes apart), and unfractionated heparin (5000 unit bolus and 1000 units/hr infusion). Sixty minutes after the thrombolysis is administered the patient complains of increasing left sided chest discomfort and shortness of breath. A repeat CXR reveals a new large left-sided collection in the pleural space. His vital signs are currently heart rate 100, BP 85/55, RR 26 and O2 sat 92% on 6L per minute via Hudson mask..
Question
| a. | Outline your management of this situation. | (100%) |
Answer
FACEM VAQ Exam 2003.1 – Question 8
- The overall pass rate for this question was 56 / 83 (67.5%).
- Examiners considered this a good question that covered a relevant scenario but included many issues other than just basic resuscitation to cover.
- These included an appreciation of alternate diagnoses to AM1 (such as aortic dissection), reversal of anticoagulation (prior to), insertion of an ICC, likely need for transfer.
- Failures tended not to cover these and ‘consider’ rather than say what
they would do.
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