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Jamal Washington, 69-year-old male, presents with sudden-onset central chest pain.
Jamal Washington
History of Presenting Complaint
5- Asks about onset and duration of chest pain (establishes acute onset 45 minutes ago at rest) +1
- Asks about radiation of chest pain to the left arm or jaw +1
- Asks Jamal to rate his pain on a 0–10 scale (he reports 8/10) +1
- Asks about associated symptoms — shortness of breath, nausea, and diaphoresis +1
- Asks whether anything makes the pain better or worse (Jamal reports no relief from rest or position change) +1
Past Medical History and Risk Factors
5- Asks about known cardiovascular conditions — hypertension, diabetes, and hyperlipidaemia +1
- Asks about smoking history, diet, and exercise (Jamal: 20 pack-year history, quit 10 years ago; poor diet; minimal exercise) +1
+ 28 more criteria across 7 domains
Which of the following is the most appropriate initial management?
- A Call 000, give aspirin 300mg chewed, IV normal saline bolus, and arrange...
- B Administer IV metoprolol 5mg to control heart rate and reduce myocardial oxygen...
- C Administer tenecteplase for thrombolysis in the GP clinic
- D Commence IV heparin infusion and monitor ECG in the clinic
- E Prescribe sublingual GTN 400mcg and morphine 5mg IV, then discharge with urgent...
This patient has an acute inferior STEMI, most commonly caused by right coronary artery (RCA) occlusion. The RCA supplies the AV node in approximately 90% of...
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Raymond
GP, Adelaide, SA
FRACGP, M.D. (Griffith University)
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George
Ophthalmology Registrar, Sydney, NSW
M.D. (University of Melbourne)
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ENT Registrar, Adelaide, SA
M.D. (Griffith University)
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GP, Adelaide, SA
FRACGP, M.D. (Griffith University)
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