Dr. Nolan, a family physician in private practice, began using her diagnostic skills almost as soon as she awoke. At 6:00 AM the hospital called telling her that Mr. Ingle, a 64-year-old patient on the telemetry unit who had been diagnosed with a myocardial infarction yesterday afternoon, was having an unusual cardiac rhythm that the nurses were having trouble interpreting. After a few quick questions to assess that the patient had a stable blood pressure and no signs of shock and to be sure that supportive measures of oxygen and intravenous fluids were in place, she ordered an electrocardiogram (ECG) and headed for the hospital. During the 10-minute ride she reviewed in her mind the diagnostic possibilities. On arrival she found a stable patient with a rapid heart rhythm (tachycardia) with a wide complex on the ECG. Through an organized and stepwise approach she was able to correctly diagnose and treat Mr. Ingle’s ventricular tachycardia, while arranging for his transfer to the intensive care unit. After a quick breakfast she completed her hospital rounds, including a complete history and physical on a new patient admitted with abdominal pain.
KeywordsChief Complaint Diagnostic Decision Advanced Cardiac Life Support Diagnostic Skill Reactive Airway Disease
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