579423

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John Carter

579423

John Carter

62 years old

Male

Attending

Dr. Emily Thompson

Insurance

Medicare

Emergency Contact

Jane Carter (Wife), XXX-555-1234

Chief Complaint

"I have had chest pain for the last 3 hours that radiates to my left arm and feels like tightness or pressure."

Medical History

- Hypertension for 15 years
- Type 2 Diabetes Mellitus for 10 years
- Hyperlipidemia
- History of smoking (20 pack-years, quit 5 years ago)
- Family history of cardiovascular disease (father died of MI at age 68)

Allergies

Penicillin (hives, itching)
Shellfish (anaphylaxis)

1000

Patient arrived via ambulance, reporting 10/10 chest pain. Appears anxious, diaphoretic, and pale. No nausea or vomiting reported, but states he feels "something's not right."

Placed on cardiac monitor, started on O2 via nasal cannula at 4 L/min. 18-gauge IV access in the left antecubital space.

Question 1

What is the significance of EKG findings?

ST Elevation on EKG: Indicates myocardial injury due to inadequate blood supply, suggesting an ongoing STEMI.

Question 2

Why was aspirin administered?

Aspirin's Role: Antiplatelet properties prevent further clot formation, which is vital in managing MI.

Scroll to see what happens next

John Carter

62 years old

Male

Attending

Dr. Emily Thompson

Insurance

Medicare

Emergency Contact

Jane Carter (Wife), XXX-555-1234

Chief Complaint

"I have had chest pain for the last 3 hours that radiates to my left arm and feels like tightness or pressure."

Medical History

Allergies

Penicillin (hives, itching)
Shellfish (anaphylaxis)

1350

Patient is drowsy but responsive. Pain reported as 3/10, localized to stent insertion site (groin). Denies chest pain. Bleeding and neurovascular checks on the femoral site are within normal limits. Urine output: 100 mL since PCI, no signs of fluid overload.

Continued monitoring on telemetry. Keeping the affected leg straight per post-PCI protocol.

Question 3

Why is telemetry monitoring essential for this patient post-PCI?

Telemetry Monitoring Post-PCI: Early detection of arrhythmias or ischemia, ensuring rapid intervention if complications arise.

Question 4

What is the purpose of administering IV heparin after PCI?

IV Heparin Post-PCI: Reduces risk of thrombus formation around the stent and supports maintaining coronary blood flow.

John Carter

62 years old

Male

Attending

Dr. Emily Thompson

Insurance

Medicare

Emergency Contact

Jane Carter (Wife), XXX-555-1234

Chief Complaint

"I have had chest pain for the last 3 hours that radiates to my left arm and feels like tightness or pressure."

Medical History

Allergies

Penicillin (hives, itching)
Shellfish (anaphylaxis)

1000 (Day 2)

Patient alert, oriented, and in good spirits. Pain at the groin site rated as 1/10, no signs of bleeding. Encouraged early mobilization with assistance. Discussed lifestyle changes and importance of medication adherence.

Assisted with mobility to chair. Educated on cardiac diet and smoking cessation.

Question 5

Why is it necessary to transition from IV to oral anticoagulation therapy?

Transition to Oral Anticoagulants: IV heparin is for acute management; oral anticoagulants are suitable for long-term prevention.

Question 6

What lifestyle modifications are critical for the patient to prevent another cardiac event?

Dietary Changes
Heart-healthy diet: Focus on fruits, vegetables, whole grains, lean proteins, and healthy fats.
Limit: Saturated and trans fats, sodium, and added sugars.
Monitor: Cholesterol levels and adjust diet accordingly.
Physical Activity
Regular exercise
Weight Management.

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