Chest Pain in Emergency - Myocardial Infarction - Essay Example

Case Study Institution Name Date Case Study Part 1a Brief Background of Chest Pain in Emergency Patients who present in the emergency department with chest pain require urgent attention because the situation can be life-threatening. Chest pain is still one of the most frequent complaints presented in patients in the emergency departments (ED). Unless the basis of chest pain is obviously noncardiac, an assessment to exclude myocardial infarction is normally initiated. However, the quality of chest discomfort does not rule out myocardial infarction. Chest pain has numerous etiologies like urgent diagnoses (i.e. pulmonary embolism, acute coronary syndrome, aortic dissection) and diagnoses that are not urgent like musculoskeletal pain. With regards to the case study, proper assessment of the situation will be imperative to ascertain the root cause of chest pain. The patient and his stage of admission Myocardial infarction (MI), also referred to as heart attack, is the heart muscle’s irreversible necrosis due to prolonged ischemia. This normally arise from oxygen imbalance in terms of demand and supply, which is mostly brought about by plaque rupture with formation of thrombus within a coronary vessel, leading to an acute decrease of supply of blood to a section of myocardium. According to Voscopoulos and Lema (2010), patients who have distinctive MI may have characteristics symptoms like; fatigue, malaise, and fatigue. Vital signs of the patient may show the following in MI: the heart rate is frequently raised due to sympathoadrenal discharge; there may be irregular due to ventricular ectopy, an increased idioventricular rhythm, atrial fibrillation, ventricular tachycardia, and supraventricular arrhythmias. Generally, the blood pressure of the patient is initially increased due to peripheral arterial vasoconstriction coming from an adrenergic reaction to ventricular dysfunction and pain. On the other hand, with myocardial infarction of the right ventricle or severe dysfunction of the left ventricle, hypotension is noted. The rate of respiration may be raised in reaction to anxiety or pulmonary congestion. Wheezing, coughing, and frothy sputum production may occur. Fever is typically present within 24 to 48 hrs (Valensi, Lorgis, & Cottin, 2011). John Smath, 71 years old, presented to emergency department with, complains of severe central chest pain and difficulty of breathing. Every acute care setting with an ED needs to have a strategic approach that is evidence-based to assessing patient that have chest pain (Burkett et al, 2014). In order to ascertain the patient’s admission, it is imperative to establish his state. Patients need to be stratified as being high risk, intermediate or low or short-term unwanted outcomes in the perspective of potential ACS (Lindahl et al, 2013). Historical information for patients presenting with chest pain is imperative in determination of symptoms’ cause as well as risk stratification (Omland et al, 2013). High risk features include and not limited to prolonged or repetitive ongoing discomfort or chest pain, and elevated degree of at least one cardiac biomarker (Backus et al, 2011). Features in intermediate risk include and not limited to resolved discomfort or chest pain within the last 48 hours, age > 65 years, presence of established diabetes, established coronary cardiac disease – past myocardial infarction (Backus et al, 2011). There may be 2 or more of these risk factors: active smoking, hypertension or hyperlipidaemia (Backus et al, 2011). Low risk features when stratifying MI involve manifestation with clinical features reliable with ACS without high risk or intermediate features (Amsterdam et al, 2010). With regards to the risk stratification features, the stage of Smath’s admission is intermediate as most of the features named are evident in his medical history. Assessment tool A couple of assessment tools of pain have been created to help offer a quantitative pain assessment and a system to assess reaction to interventions (Backus et al, 2010). The assessment tool chosen for this case study is the Emergency Department Chest Pain Medical Assessment Tool. This assessment is effective because it is considered comprehensive. One of the assessments done is head to toe assessment. This involves a physical examination where inspection or visual examination is carried out. Palpation, which entails examination using sense of touch, is used to establish patient’s temperature or pain. According Araguás & Font (2011), percussion is also involved and this is about striking the body indirectly to bring out sounds. The produced sounds are: dullness (liver), tympani (abdomen), hyper resonance (lung/emphysema), resonance (lungs), flatness (bone). Lastly, auscultation involves listening to sounds within the body. A comprehensive assessment is imperative as (Hess et al, 2010) state that missed diagnosis, with related unwanted outcomes, can take place when assessment of chest pain is grounded on clinical presentations alone. Part 1b The subjective and objective findings will be presented as follows on the assessment tool. Subjective Data severe central pain radiating to his left arm and his back lack of appetite difficulty in breathing vomiting agitated, restless general malaise smoked for 20 years lack of physical activity (obese) Objective Data peripheral edema sweating temperature 36.7 degrees Celsius BMI=29 BSL= 12mmol after meal ECG done Negative findings for the patient Pain score 8/10 Vital signs: P=55, BP=150/70, Spo2=93% 6L Hudson musk, RR=24, BLS=12 mmol after meal. Arrhythmias Pain is frequently considered as the 5th vital sign with regards to healthcare since it is acknowledged presently in healthcare that pain, just like any other vital sign, is not a subjective but an objective sensation. Most assessments of pain are performed in the scale’s form. The patient is briefed about the scale and they provide a score. Number scale is one of the scales used in assessment of pain. Pain is rated on a scale from 0 to 10 indicates absence of pain, while 10 is the worst pain possible (Hess & Jaffe, 2012). With regards to the case study where the patient’s pain score is 8/10 indicates that the patient is indeed in great pain. The patient’s SpO2 was noted as 93% on 6L Hudson musk, indicating a decrease. A normal healthy individual should have his or her level of SpO2 at 95-100%; although this might vary depending on various factors like age or a couple of disease processes. Another abnormal finding on the patient’s assessment is the respiratory rate which is 24 breaths/minute. The normal range of respiratory rate in a healthy adult is 12-18 breaths/minute (Lindahl, et al. 2013). The patient’s pulse rate was noted as 55 beats/minute. This indicates a decrease from the normal heart rate which is 60-100 beats/minute. The normal blood pressure in adults should be Read More