Users' Guides to the Medical Literature
Guyatt G, Rennie D, Meade MO, Cook DJ
Part B Therapy
Chapter 11.1. Applying Results to Individual Patients
Antonio L. Dans, Leonila F. Dans, Gordon Guyatt
Clinical Scenario
Topics Discussed:
clinical decision making, myocardial infarction, thrombolytic therapy
Excerpt:
"You are the attending internist on duty when a 40-year-old history professor
presents to the emergency department of a general hospital in the
Philippines. He has experienced severe chest pain for 2 hours, associated
with clammy perspiration. The pain is now settling, and the patient
is not feeling dyspneic or otherwise in distress. Physical examination
reveals a blood pressure of 110/70 mm Hg, a heart rate of
92/min, a normal first heart sound, and clear lungs. An
electrocardiogram discloses 3-mm ST-segment elevation in leads II,
II, and aVF, suggesting an acute inferior wall myocardial infarction
(MI). As nurses place intravenous lines and prepare the patient
for admission to the coronary care unit, you consider the possible
benefits and risks of administering thrombolytic
therapy. Because, to be fully prepared to advise just this sort
of patient, you have recently examined the literature, you move
quickly and confidently to the bedside...."
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