1. By Christopher I’Anson SJA Advanced Student Doctor and Training officer (2012-13) Keeping your finger on the pulse: Heart and Lungs

2. Aims and Objectives Subjects: Chest pain ACS Angina PE MSK Breathless Asthma COPD PE

3. Causes of Chest pain Write some causes of chest pain on the board Cardiac:Respiratory:Vascular: ACSPEAortic discetion AnginaAsthmaAortic sheer PericarditisInfectionsSickle Cell disease Gastric:MSK:Neurological GastritisCostocondritis Psychiatric OesphagtitsRib # Reflux/HeartburnPulled muscle Trauma

4. SOCRATES is a pain! Site Onset Character Radiation Associated symptoms Timing (before, during, after) Exacerbating and Alleviating factors Severity (1-10)

5. Coronary Vessels

6. ACS: Acute Coronary Syndrome STEMI Non-STEMI Unstable Angina

7. Clinical Features Chest Pain (crushing) Arm +/or neck pain +/or abdominal pain SOB Cool Clammy Sense of Impending doom Nausea and Vomiting Dizziness DEATH

8. Management: ACS Monitor Ask for AED and Oxygen (give O 2 if you can) Aspirin 300mg under tongue or chewed DO NOT SWOLLOW!!! Ambulance HCP if available

9. Angina Momentary blocking/ narrowing of arteries Clinical Features: Chest pain Relieved by GTN and rest Similar to ACS

10. Management: Angina Angina: Rest Get patient to take GTN if they have it Monitor If 1 st episode go to hospital If GTN not relieved treat as ACS!

11. Breathlessness Causes: Asthma COPD PE Exercise Anaphylaxis Shock Trauma

12. OD PEAR Onset Duration Progression Exacerbation Association Relieving What do you get when a pear falls from a tree? Answer: Pear drops

13. Common Presenting Complaints Cough ? Productive ?blood Wheeze Chest pain SOB Fever/night-sweats/rigors ???Calf pain???

14. Lungs: Anatomy and Physiology Airways: Trachea Bronchi Bronchioles Alveoli Gas exchange

15. Asthma Is a long term (chronic) condition characterised by and reversible airway obstruction due to bronchospasms... Symptoms: SOB/ increased RR Cyanosis Cough Mx: Get pt to use inhaler Sit in a good position Oxygen if needed

16. COPD Chronic disease of lungs: Bronchitis and Emphysema CF: SOB Cough Cyanosis Mx: Same as asthma WARNING: use O 2 with caution

17. DEMO The Final Straw!

18. Medicines of COPD and Asthma

19. PE Blood clot in the pulmonary artery CF: Cough blood (not always) Chest Pain SOB Neck vein distension Pain in calf Mx: Oxygen and Hospital ASAP

20. Making sure your history is AMPLE Always ask AMPLE A M P L E

21. THANKS FOR LISTENING Any questions? ?