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* severe aortic stenosis ccs
 #230208  
  welcome1 - 10/11/07 15:51
 
  Hotobhago or anyone please!!! for steps with pt AS

Thanks in advance
 
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* Re:severe aortic stenosis ccs
#984127
  honeysuckle - 10/11/07 16:01
 
  it would depend on the presentation
but the main points would probably be
2d echo
cardiothoracic consult for aortic valve replacement
digoxin
carvedilol
I and O
morphine if with chest pain or pulmo edema


at least that's how i would do it...
do they really give such tough cases for ccs?
 
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* Re:severe aortic stenosis ccs
#984295
  welcome1 - 10/11/07 16:54
 
  Atleast i got in my exam
 
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* Re:severe aortic stenosis ccs
#984303
  welcome1 - 10/11/07 16:55
 
  Pt presented with chest pain and light headedness. Why digoxin and what is i and o.
thnks honeysuckle
 
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* Re:severe aortic stenosis ccs
#984364
  hotobhaga - 10/11/07 17:17
 
  pt comes tro the ER with SOB/syncopal/chest pain
SOB
iv acsess. pulseoxymetry.o2.caridiac monitor.12 lead ecg, finger stick glucose. cardiac enzymes
limited exam will rule out chest desease, pneumothorax, pneonitis, copd
murmur will be heard confirming diagnosis

syncopal episoded: neuro exam will be normal, glucose will be normal
chest pai: ECG will be non-mi features

Once u know that an AS murmur is present start NS, Nitroprusside, lasix to decrease afterload.
Then do 5 min Bp checks asthe pt is on nitroprusside
Ask for cbc.BMP,lft. pt/ptt, FOBT, 2decho, ctscan brain, electrolytes, UA, Lipid profile
If the pt is in CCF( as will be shown by the chest exam , JVD 2decho) start digoxin..otherwise dont ..in any case digoxin will not have any acute effect
Pt improves shifty location to ward, put folley maintain out put chart
salt restricted diet, aspirin see if u can DC O2 oan IV fluids and make oral meds
2 D report says AS. take surgical opinion as the pt is symptomatic
Dc the patient on
Aspirin
low salt diet
seat belt
safe sex
no smoking
moderate alcohol
excercise counsel
medication counsel

counsel antibiotic prophylaxis before dental procedure
 
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* Re:severe aortic stenosis ccs
#984405
  aiissman - 10/11/07 17:36
 
  lasix to decrease afterload?????

I think diuritics dec. preload hoto not afterload.
 
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* Re:severe aortic stenosis ccs
#984429
  hotobhaga - 10/11/07 17:45
 
  sorrry mistake.. lasix for preload and nitroprusside for after load  
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* Re:severe aortic stenosis ccs
#984534
  honeysuckle - 10/11/07 18:45
 
  Hoto is right, I thought of digoxin because I "predicted" the case had CHF since it was an ER presentation.
I and O is input and output...again because I thought the patient was in CHF
that was a real tough one! did it end early? well, cheer up, you are done. just await your scores, and pray, pray, pray!!! gluck
 
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* Re:severe aortic stenosis ccs
#984540
  hotobhaga - 10/11/07 18:48
 
  ACEI should also be given in this case  
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* Re:severe aortic stenosis ccs
#3390689
  aliston - 10/26/20 08:53
 
  He also describes the signs doctors should look out for in their patients, including heart sounds, blood pressure and pulse.

Heart Diagnosis
 
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