MedBugs: SAQ #163

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Case: Chest pain

You are the ED consultant in a small rural hospital 2 hours from the nearest tertiary centre. A 60-year-old female has acute onset chest pain for 60 minutes. The pain is dull left-sided, non-radiating, somewhat pleuritic, and she is more comfortable sitting upright than lying flat. She is diaphoretic. Background: T2DM, hypertension, chronic renal failure on peritoneal dialysis (awaiting transplant), dyslipidaemia, ischaemic heart disease, obesity. Vitals: Temp 37.0 HR 100 BP 140/80 RR 24 SpO2 95% RA GCS 15. ECG provided.

1. State the most likely diagnosis and the most concerning differential diagnosis for the ECG. 2 marks

2. List three relevant positive ECG features consistent with your stated likely diagnosis. 3 marks

3. List two relevant negative ECG features consistent with your stated likely diagnosis. 2 marks

4. Outline four priorities for your ongoing management. Include drug doses where relevant. 4 marks

5. What is an important consideration for definitive management with respect to your main differential diagnosis? 1 mark

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