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  #1  
Old 08-21-2012
DRFP's Avatar
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Default CCS Pericarditis

Pericarditis case

since it starts as Chest pain I
do the following

ECG 12 lead
ECG monitor
Oxygen
Pulse OX
ASA
IV

then a focused exam
general
CHest
Heart
Abd

then order

CBC
BMP
CKMB 8 hours
Troponin 8 hours
CXR

all stat

when the EKG comes back and it looks like Pericarditis
with the symptoms now
I order
Echo
Ibuprofen

I put them on the ward

I D/C to home after the fever is broke

does this look right?

USMLE world is not working right with this no changes for 4 days then the fever breaks

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  #2  
Old 08-21-2012
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Default

Quote:
Originally Posted by DRFP View Post
Pericarditis case

since it starts as Chest pain I
do the following

ECG 12 lead
ECG monitor
Oxygen
Pulse OX
ASA
IV

then a focused exam
general
CHest
Heart
Abd

then order

CBC
BMP
CKMB 8 hours
Troponin 8 hours
CXR

all stat

when the EKG comes back and it looks like Pericarditis
with the symptoms now
I order
Echo
Ibuprofen

I put them on the ward

I D/C to home after the fever is broke

does this look right?

USMLE world is not working right with this no changes for 4 days then the fever breaks


Add predinsone
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  #3  
Old 08-22-2012
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Quote:
Originally Posted by Anders View Post
Add predinsone
USMLE World says no prednisone it will be a negative mark

just Ibuprofen
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  #4  
Old 08-22-2012
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Always add head exam to cardiac issues ...
Is there an effusion on echo? Maybe that's why it's not getting better.
Also, if fever, I would go for cultures (everything you can think of), and add serology to routine tests (to figure out why this guy has pericarditis).

And I agree, if there's no resolution of fever, either add prednisone or dig deeper, there might be something we're missing, an infection somewhere else, an effusion, an associated autoimmune disoder, malignancy, TB, etc.
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