A 54-year-old male patient arrives in the emergency department complaining of severe chest pain that radiates...

A 54-year-old male patient arrives in the emergency department complaining of severe chest pain that radiates to his mid-back along with dyspnea. He is morbidly obese, has smoked two packs of cigarettes a day for the past 20 years, and has two immediate family members who have died of heart disease.

1. What does the ED physician suspect is causing the patient’s symptoms?

2. What tests should the ED physician order?

3. Will surgical intervention be necessary, and if so, what procedure?

4. What procedure is typically attempted before surgery, where is that procedure performed, and by what type of physician specialist?

5. Describe what occurs when a patient experiences a mediastinal shift.

Expert Solution

1. What does the ED physician suspect is causing the patient’s symptoms?

Myocardial infarction(Heart attack ).As the patient is having chest pain with radiation ,positive family history of heart attack and smoking habit ,likely to be Myocardial infarction.

2. What tests should the ED physician order?

ECG
Blood test for cardiac enzymes

3. Will surgical intervention be necessary, and if so, what procedure?

Surgical intervention decision will be depends on the cardiac catheterization study results.if major vessel or multiple vessel involvement for the MI.Then CABG-Coronary artery bypass graft is the surgical intervention .

4. What procedure is typically attempted before surgery, where is that procedure performed, and by what type of physician specialist?

If the patient is confirmed as an MI.Then coronary angiogram to be performed and if needed angioplasty to be done.It will be done in cardiac cath lab by an interventional cardiologist.

5. Describe what occurs when a patient experiences a mediastinal shift?

Mediastinal shift occurs when the mediastinal structures (Heart,great vessel,trachea and oesophagus) shifted or pushed to one side of the thoracic cavity .It is usually associated with pneumothorax associated with chest wall injury.Symptoms may be dyspnea,cyanosis,distended neck veins etc.

Nightingale answered 2 years ago

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