On Tue, 1 Mar 2005 15:37:06 -0000, Paul Bromley <[log in to unmask]> wrote:
How long
> did they keep him in before they decided otherwise.
>
Long enough to do an ECG and CXR :)
I agree that it sounded ischaemic - this was never really in doubt -
and if his obs had been fine then I would have done gtn, beta blockers
and CP clinic. But they were not fine. The worry would have been
that this bloke had had an MI sometime in the past few days and now
had an arrhythmia. His presentation as an e/a perhaps precipitated by
him feeling iller in the past few days b/o this - even though he found
it hard to explain why he was presenting as an e/a. Plus his BP was
rather on the high side, even for Lanarkshire.
I reckoned he needed an ECG today before we could confidently say
there was no acute issue. I said to the med reg that I would do the
same again, essentially, and she was none to pleased by this but,
hey-ho, my neck/the patient's life.
But there is no black and white really. I guess what I would like to
know is how long we could safely have sat on this guy till he got an
ecg? My gut feeling was not very long, but others seem to think a few
days would have been ok. Dunno. ECG showed "some bigeminy" in the
end up. Can't say I diagnosed that from his pulse though.
--
Paul
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