The Diagnosis of the Medical Situation: Acute Coronary Syndrome Diagnosis - Term Paper Example

tеntiаl Aсutе Cоrоnаry Syndrоmе Diagnosis Institution Name Date Table of Contents Table of Contents 2 Diagnosis 3 Patient’s Background 3 The possible diagnosis 4 The pathophysiology a Myocardial Infarction 4 Clinical features 5 Paramedic intervention and rationale 5 Hospital emergency management 7 A critique of the evidence supporting the management practices 8 Conclusion 8 Introduction Acute coronary syndrome (ACS) includes the broad spectrum of clinical presentations that range from the ones exhibited in STEMI (ST-segment elevation myocardial infarction) to NSTEMI (non-T-segment elevation myocardial infarction), as well as in unstable angina. The syndrome usually involves a rupture of the atherosclerotic plaque, as well as a complete or partial thrombosis of infarct-related artery. In this essay, a case will be used in trying to diagnose a possible acute coronary syndrome (Kumar & Cannon, 2009). The case used here is that of Bob, a 35-year-old man who works in a factory. The patient is experiencing central chest pain that radiates into the jaw. He is also pale, clammy, and distressed. The essay will comprise the diagnosis of the medical situation, as well as the paramedic intervention and rationale, with the identification of the gaps in the therapies. Diagnosis Patient’s Background From the patient’s medical history, he has no previous complaints of chest pain. He also has GORD, asthma, HT, and a controlled type 2 diabetes mellitus. He is also on several medications including salbutamol inhaler, atenolol, Breo-inhaler, omeprazole, and paracetamol PRN. Again, he is allergic to penicillin. At the same time, he has no known communicable diseases, and his vaccinations are up to date. He lives with his partner; his father died at 41 years old of heart disease, and the mother died of breast cancer. He is a social alcohol consumer and smokes 30 cigarettes a day. The possible diagnosis The man could have been suffering from an acute Myocardial Infarction/heart attack. The pathophysiology a Myocardial Infarction Acute myocardial infarction refers to a segmented myocardial necrosis based on the endocardium that is secondary to an epicardial artery occlusion. A heart attack occurs when the heart lacks the ability to provide the needed blood flow that is used in meeting the metabolic requirements as well as enhance the accommodation of the venous return. This is usually due to an injury in the myocardium due to many reasons. In this scenario, the coronary artery that was damaged is the Left anterior descending (LAD) coronary artery, which leads to anterior acute myocardial infarction (Postma, Bergmeijer, ten Berg, & van’t Hof, 2012). Due to the failure of the heart, the patient will develop symptoms like dyspnea that originate from the impaired venous return, pulmonary congestion, as well as peripheral edema. This will cause him to have symptoms like lack of appetite, nausea, and fatigue, as well as a chest pain. When the heart is failing, some compensatory mechanisms also occur such as an increase in the cardiac output, wall thickening due to ventricular remodeling, an increased ventricular volume, and the maintenance of tissue augmentation. At the beginning of the heart failure, these compensatory mechanisms are important. However, they eventually create a vicious cycle that only worsens the condition. Having seen the medical and family history of the patient, the only practical condition that he may be dealing with is a heart attack (Shiyovich, & Plakht, 2016). Clinical features The clinical features of a heart attack include chest pain, which may travel to the arm back, shoulder, jaw, or neck. It also includes nausea shortness of breath, cold sweat, and a feeling of tiredness, as well as malaise (Wong et al., 2012).. Paramedic intervention and rationale A heart attack is a very serious condition that needs to be handled as a medical emergency. The victims of a possible heart attack are usually warned by an episode or episodes of angina that is accompanied and characterized by chest pain. The chest pain is usually provoked by ischemia. There is only a small difference through. With angina, the flow of blood is restored, and the pain reduces in minutes. However, following a heart attack, blood flow is reduced considerably or is blocked totally ("Heart attack Treatments and drugs - Mayo Clinic", 2016). Without getting a fast treatment, the heart muscles die. It is thus vital that the paramedics give the patient fast care before he gets to the hospital to reduce damage. Before the patient can be taken to the hospital, the diagnosis of STEMI patients can be made in two ways. The first way is by making the diagnosis in the ambulance through the emergency medical services (EMS) call of 911 or 118 by the general practitioner or the patient. The second one is by taking the patient to a non-PCI center prior to the performance of an ECG in the ambulance by the EMS. The ambulance diagnosis is better because treatment can be started immediately even in the ambulance (Alensi et al., 2011). In the ambulance, the paramedics can conduct various assessments to help them handle the patient well and prevent total damage of the heat. Since the patient has chest pain, the following assessments should be done ("Understanding Heart Attack -- the Basics", 2016). 1. Re-evaluation of breathing , the airways, disability, circulation, and exposure 2. Establishing an advanced airway in case it is not in place already 3. Re-evaluation of ventilation, oxygenation, and temperature control 4. Acquiring a 12 lead ECG but ensuring transportation is not delayed. 5. Treating the causes of precipitation 6. Checking the vital signs like body temperature, respiration rate, blood pressure, and pulse rate It is important to re-evaluate the breathing just to ensure the heart has not stopped. The airways should always be kept open to allow air to get into the lungs. The paramedics must also ensure there is an advanced airway because the patient may not be able to breathe on his own. The temperature should also be monitored because a fever may overwork the heart even more. At the same time, oxygen is important in maintaining the patient’s heart. There should also be adequate ventilation to avoid the congestion, which inhibits oxygen flow. It is also important to acquire a 12 lead ECG because it helps classify the patient into ST segment elevation, depression, or those that are non-diagnostic. Since the diagnosis is an anterior acute myocardial infarction, the ST segment elevation of the anterior leads is V3 and V4, which is about 0.2mV in the J point. At the same time those of the ST segment depression in the inferior leads will be I,II and aVF (Postma et al., 2012) The pre-hospital care for a patient with chest pain may involve giving supplemental oxygen, intravenous access, and pulse oximetry. They also administer aspirin immediately en route and spraying or sublingually administering Nitroglycerin for the chest pain. Pre-hospital ECG and telemetry are also given. Hospital emergency management At the hospital, the patient can undergo a variety of treatments. When a patient that is suspected of MI with an acute pain is brought into the emergency department, the patient can be given a sublanguage medication with nitroglycerin since he does not have any contraindications to the drug. If the patient has an STEMI, he should be given a beta-blockers initiation. In case he is found with STEMI, a decision must be made very fast, as to whether the patient should get a primary percutaneous coronary intervention (PCI) treatment or thrombolysis. He was also given an anti-ischemic therapy. The following interventions should thus be given, that is, administering intravenous medications as well as therapy that are meant to reduce the extent of the MI, salvaging the destroyed ischemic myocardium, and recanalizing arteries that are infarct-related (Anthony, 2011). The doctors can also give antiplatelet agents to help with the prevention of clots, blood-thinning medicine to reduce the stickiness of the blood, pain relievers to ease the pain, and ACE inhibitors to reduce stress and lower blood pressure. If the damage had been big already, coronary stenting and angioplasty could be used. This is done by inserting a catheter through an artery in the groin or leg to the artery blocked in the heart in order to locate the blockages. A surgery of the coronary artery bypass can also be done during the attack to sew the arteries and veins in place, thus allowing the blood to flow through the heart but bypassing the section that has been narrowed. The patient will thus have to stay in the hospital for a few days to enhance healing (Mayo Clinic 2016). A critique of the evidence supporting the management practices According to South Australia’s clinical practice guide, the following type of care needs to be given to a patient with a coronary artery disease. They recommend that a 12 lead ECG be reached. With chest pain, the patient should be given a sublingual GTN 400 microgram every five minutes if the pressure is adequate, ECG appropriate, the patient has not used Levitra and Viagra within 24 hours and Cialis within 48 hours (Shaw & Tofler, 2009). They should also give an oral 300mg IV cannula and to provide transportation and notify the receiving facility. The GTN sublingual and morphine should be co-administered. The preferred PCCI healthcare facility should be the one within 60 minutes or less. For the patient that is unconscious, cardiopulmonary resuscitation activities should be carried out in a ratio of thirty compressions and two ventilations at the rate of one hundred compressions every minute. This should be followed by assessing rhythm and life every 2 minutes as well as life. Therefore, the above interventions used on Bob were up to standard (Mallinson, 2010). Conclusion Coronary heart disease is one of the diseases that cause many deaths. In this report, the case that was being studied is that of Bob, who was found distressed with chest pain that extended to the jaw, and clammy. With this, it is very clear that the patient was suffering from a heart attack. The diagnosis was reached based on the clinical features of the disease, medical, family, and social history. It also contains the pathophysiology of the disease, the paramedic interventions, and care. At the same time, it describes what is done at the hospital to save the patient. With the critical analysis of the Australia’s clinical practice guide, the care given to the patient was up to date and in agreement with the guide. References Alensi P, Lorgis L, Cottin Y; Lorgis; Cottin (March 2011). "Prevalence, incidence, predictive factors and prognosis of silent myocardial infarction: a review of the literature".Arch Cardiovasc Dis 104 (3): 178–88. doi:10.1016/j.acvd.2010.11.013 Brown, Anthony (2011). Emergency Medicine Diagnosis and Management 6th Edition. Doolub, G. (2008). PRE-HOSPITAL THROMBOLYSIS IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION. Chest, 134(4), p84003-a-p84003-b. http://dx.doi.org/10.1378/chest.134.4_meetingabstracts.p84003 Fellows, S., & Fellows, B. (2012). Paramedics: From Street To Emergency Department Case Book. Maidenhead: McGraw-Hill Education. Heart attack Treatments and drugs - Mayo Clinic. (2016). Mayoclinic.org. 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