MAEM MEI 2013

1. Encik A berumur 24 tahun di bawa ke Jabatan Kecemasan kerana mengalami sakit dada teruk, sesak nafas dan berpeluh.
Pemeriksaan mendapati ECG ST Elevation Lead V1, V2, V3, V4. Troponin T increased.
a. Senaraikan empat diagnosis perbezaan kes ini (2m) - Cardiac failure and cardiogenic shock
- Thromboemlism
- Cardiac rupture
- Pericarditis
- Post-Infarction Angina
- Left Ventricular Aneurysm
b. Terangkan bagaimana mendapatkan sejarah sakit dada yang
lengkap (6m)
c. Terangkan pengurusan kes ini di Jabatan Kecemasan (12m) i. ECG Monitoring for at least 48 hours - To role out STEMI
ii. Oxygen 2-4L/min for 2-3 hours and continue if SPO² <90%
iii. Antiplatelet – Tab Aspirin 300 mg STAT
iv. Analgesia
- Morphine 5-10 mg IV Slow Bolus with Anti Emetic IV
Metoclopramide 10 mg.
- Sublingual Nitroglycerin 0.3-0.5 mg repeated every 5 minutes
till 3-4 doses given
v. Regular leg exercises and low dose of Heparin
- SC 5000 unit BD
- To prevent deep vein thrombosis
vi. Sedation small oral doses
- Diazepam and Lorazepam
vii. Diet and bowel care – liquid soft
viii. Potassium levels maintained at 4-5 mmol/L
2. Encik A dibawa ke Jabatan Kecemasan dengan aduan terminum racun paraquat.
a. Senaraikan empat manifestasi klinikal pesakit (3m)