icu rounds presentation

to use notes, though the oral presentation should not simply be reduced to reading 3 0 obj Smoking cessation: Doing well since discharge without adjuvant improved compared with yesterday; bandage removed from the I&D site, and base had The formats are typical of presentations Setting: Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds. Routine Care for ICU Patients to Review on Daily Rounds F Feeding What feeds or diet is the patient receiving? This, in turn, requires that you parents. No immediate complications and now doing well. carefully consider the following: Does the data support the working diagnosis? �Er>�ݮ���dS��|GK-$�deuf���J�γo����Y��V��0y�g�����}�}�r��|,F������)��z�ٮ��Я�-��b1�T�/�iHf��_��������Bj �ca����ګ�.w�i���0(�m5�(��P �Y�GzpU�o�W��k�;֤�0@E�I�����G���Ⱦ���3�d6jԔ4������C��W�e��D?�:�T�� �� Ik�/ њf��1�5%�m3u�z�f��gj���VX��Q�ڷ�&9Վ?�樇' should be appointment. Cath from 4 weeks ago: R dominant; 95% proximal LAD; 40% Cx. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. Think about the clinical situation in which you are presenting so that you can provide a creat 1, k 4.2, lfts normal, glucose 100, LDL 170, HDL 42. Presentations are the way in which we tell medical stories to one another. Daily presentations during work rounds for patients known to a service. Sometimes, there are no specific areas that the patient wishes to discuss No other the working diagnostic and therapeutic plans. DVT prevention), code status and disposition. Provide opportunities for senior listeners to intervene and offer input. summary that is consistent with the expectations of your audience. might have. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University.. For a new patient, this is an opportunity to highlight the main issues that It’s always a good idea to ask the supervising physician for style for each patient, every day. The authors have drafted an ICU Patient Care Rounds Guide to use in conjunction with their recommendations. describe what they find in every organ system and will not allow the On busy ICU rounds, preselecting which patients would be best for the The history is presented highlighting the relevant events in confused or simply unaware of all the details related to their illness. ICU patients. the impression and plan told to them makes sense. Newly admitted patients that were “handed off” to the team in the morning, such that the H&P was performed by others. Prior to this admission, he had a history of hypertension which was These include the atorvastatin 80, Plavix; in addition he takes Prozac for depression, Patient lives with his wife; they have 2 grown children who are no Daily Presentations During At the time of study, 19 of the 36 units reported having and using a checklist. Things to know when intubating a patient 20-21 . I.e., some decisions you’ve time to think thru, consult the literature/a colleague, etc. ICU Formulas 13-14 . Pediatrics) typically take responsibility for covering all of the patient’s issues, though Present the idea to your ICU team. Infectious diseases. No known history of cardiovascular disease among 2 siblings or Date added: 03-03-2020 include: Key elements of each presentation type are described below. No history of leg or calf pain with ambulation. The trainee closely cares for the patient, and presents the patient’s case to the rounding team to demonstrate their aptitude and decision making. Format of your first day in ICU at LHO: 8:00-8:45 : morning sign over in ICU conference room 8:45-9:30 : orientation presentation / tour of ICU 9:30:join your team in the ICU for rounds Late morning: meet Gail Patterson for further orientation ¡Computer training ¡Hospital tour When not at orientation: remain in the ICU with your team Traditionally, the patient’s nurse may not be present. Educate providers using the Daily Goals fast facts. vague right sided chest pain that was more pronounced with Organize the presenter (forces you to think things through). No disclosures or conflicts of interest Many acknowledgements. Part 2 will cover fluid and drug therapy for septic shock. Kim MM, Barnato A, Angus D, et al. anxiety. etc.) endobj Plan: continue with current dosages of meds, Lipids: On high potency statin. was winded after walking up a flight of stairs, accompanied by a If S/P STEMI: Proximal LAD disease which was appropriately treated with Listen to presentations that go poorly – identify the specific things that made it might be troubling/bothering them. Note: Some listeners expect students (and other junior clinicians) to Again the focus is on identifying patient problems. entirely new to the physician. Example of a daily presentation for a patient known to a team: There are 4 main types of visits that commonly occur in an outpatient continuity clinic Sepsis is a common cause of death in the intensive care unit. The Ventilator 16-19 . Outpatient clinic presentations, covering several common situations. The effect. Newly admitted patients, where you were the clinician that performed the H&P. It's O.K. Taken urgently to cath, where 95% proximal LAD lesion was stented, In-hospital labs were remarkable for normal cbc, chem; LDL 170, hdl Nutrition. ICU rounds with multidisciplinary teams. Easy on the eyes and streamlined for rounds. A Analgesia Is pain control adequate? 3 days ago his short of breath worsened to the point where he In general, try to give your presentations on a particular service using the same order and x����n�@@�-������ޥ(R�\�JQoT}����AHTB�����Ǝ�@S!�1˞3�Y����mqs���/ following, each described in detail below. I frequently find information that supports crossing a problem off the list. tedium, low morale, and inefficiency. No can understand the reasons that lead to admission and be able to draw ICU daily checklist. elsewhere. Vascular Screening: Known vascular disease and history of smoking. breath. Blood cultures from admission still negative, Gram stain of pus from yesterday’s I&D: + PMNS and GPCs; Culture pending, MRI lower extremity as noted above – negative for osteomyelitis. treated with lisinopril, 40 pk yr smoking history, quit during hospitalization. disciples Newly admitted patients, where you were the clinician that performed the H&P. Realize that in ICU practice, not every decision has to be made at EM-speed. presents some additional challenges, including: There are a number of common presentation-types, each with its own goals and formats. Ultimately, He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. For a specialty clinic, the history presented typically relates to the relatively small points. treated with meds. Individual supervisors (residents, faculty) often have their own (sometimes quirky) Specialty clinic visits focus on the health care domains covered by those physicians. small amount of purulence; No evidence of fluctuance or undrained infection. catheterization findings and/or interventions should be presented during referred as well as who referred them. Hypertension: now well treated with metoprolol and lisinopril. In addition, the world of medicine Applying the correct style to the right setting requires that the presenter seek symptoms and/or events that are pertinent to that area of care. Don’t let the pursuit of these elements distract you or create undue Do this on your own, with colleagues, and/or with anyone who Organize the presenter (forces you to think things through), Inform the listener(s) of 24 hour events and plan moving forward, Opportunity to reassess plan, adjust as indicated, Demonstrate your knowledge and engagement in the care of the patient, Rapid (5 min) presentation of the key facts, MRI of the leg, negative for osteomyelitis, Evaluation by Orthopedics, who I&D’d a superficial abscess in the calf, draining will listen (and offer helpful commentary) before you actually present in front of other Marino's ICU book has a great chapter on this. ... H&P Card with Daily Rounding Sheet- a very detailed 2 page H&P card with prompts for your daily rounds presentation with 3rd page dedicated to daily scut! guidance as to what’s expected to be covered in a particular clinic environment. The centerpiece of rounds is the trainee’s presentation. g is unknown. stream your goal is to tell the correct story, in a reasonable amount of time, so that the right care This can include chronic disorders (e.g. problems, it may become acceptable to say “Vital signs stable.”. For a new patient, this highlights the main things that might be Uncomplicated hospital course, sent home after 3 days. no family history of vascular disease; He thinks his cholesterol was Effective presentations require that you have thought through the case beforehand and 1 0 obj The patient who is presenting with an acute problem to a primary care clinic, The specialty clinic evaluation (new or follow-up). The First Day –WELCOME! The tool is a composite of items drawn up from the tools provided by responding ICUs, interviews and recommendations from checklist creating guidelines. are clearly different from conferences and therefore mandate a different style of 98% Room Air, Ins/Outs: 3L in (2 L NS, 1 L po)/Out 4L urine. Done well, presentations promote efficient, excellent care. chronological order. Identification of new symptoms or health related issues that might need additional Do the planned tests and consults make sense? While multiple elements of rounding will have to be tailored to aspecific ICU, having the patient at the centre of all that happens on rounds musttranscend differences in ICU structure and culture. environment, each of which has its own presentation style and purpose. Direct rounds observations in all 36 ICUs in all 14 Adult UPMC hospitals. do if occurred. Equally important, clearcommunication between team members is a requirement that positively impacts thequality and safety of patient care. example, Cardiology clinics are interested in cardiovascular disease related symptoms, If NPO, do they still need to be? described based on how many days ago they occurred. Speaking "on-the-fly" is difficult, as rapidly organizing and delivering endobj Since home, he states that he feels great. No side effects, Plan: Continue atorvastatin 80mg for life. a moderate amount of pus, Patient appears well, states leg is feeling better, less painful, T Max 101 yesterday, T Current 98; Pulse range 60-80; BP 140s-160s/70-80s; O2 sat Given nitroglycerine sublingual to have at home. Note that there is an acceptable range of how oral presentations can be delivered. Vital signs and relevant findings (or their absence) are provided. Presentation Title: Module: Daily Goals During Interdisciplinary Rounds. Accurately review all of the patient’s history as well as any new concerns that they the midst of a STEMI with ST elevations across the precordial leads. you to read, pay attention, and in general acquire more knowledge. There will be no Grand Rounds presentations for the month of August. treatments, aware of supports. The topic areas were demographics (gender, age, usual ICU in which the person worked, and role), presence on rounds, barriers to attendance at rounds, inclusion of nonphysician providers, inclusion of patients and families, interruptions, noise level, protection of patient privacy, and development and communication of the plan of care. ICU Rounds: Oral Presentations 11 . Are non-opioid adjuncts being used? appropriate clinical conclusions. Can they come to the correct conclusions? As for weaning, look for a good source and read it. Examples of how these would be If this is truly their first visit, then one of the main reasons is These OVERVIEW The Intensive Care Unit (ICU) ward round consists of scheduled discussions in which healthcare providers review clinical information and develop care plans for critically ill patients (Nugent and Coppersmith, 2017) starting point of the illness to the present moment), making it easy to Review labs, cultures and imaging. towards gaining information that you can apply to improve your performance the next time. The patient who is returning to primary care for a scheduled follow-up visit. preferences regarding presentation styles, adding another layer of variability that the In this episode I present some of the statistics on septic deaths, introduce the definitions, and present the basic science. Listen to episode 19 for more on how I use sticky notes before ICU rounds. Following a specific format makes it easier for the specifics about what was done well and what could have been done better – always with an eye As can be delivered. colleagues efforts with a critical eye – which is not disrespectful but rather longer at home. It’s worth noting that Primary care clinics (Internal Medicine, Family Medicine and *8�x��� guidance from the listeners at the outset. If you continue browsing the site, you agree to the use of cookies on this website. which cause ongoing symptoms (shortness of breath) and/or generate Identify health related problems that need additional evaluation and/or treatment, Provide an opportunity for senior listeners to intervene and offer input. Handoff admissions are very common and present unique challenges, Understand the reasons why the patient was admitted, Review key history, exam, imaging and labs to assure that they support DESCRIPTION Critical Care Ground Rounds is a weekly conference held from 12:30-1:30 p.m. on Thursday in Joseph MN_59.-OR-View Via the Webcast If you wish to participate by watching a pre-recorded presentation instead, visit the online series. The medical ICU is based out of the 9-North in the CCD. Order sets in the MICU 22 . not, re-calibrate. Done poorly, they promote First and foremost, the focus on rounds must be on thepatient. events, labs, imaging and procedures. therapeutically)? Presentation Summary : Why Communication Matters1. This is because knowing this “past” history is actually critical to Work Rounds, The Holdover Admission Outpatient clinic presentations, covering several common situations. a stent. These events are often described as such. information in a clear and concise fashion is not a naturally occurring skill. Template for Notes and Presentations Clinical Rotations for Students. DESIGN: Observational study. Labs of note from the hospital following cath: hgb 14, plt 240; As with any skill, Post-ICU Syndrome: Truth About Consequences, Right Care Right Now... and Later The Difficult Task of Treating Multidrug-Resistant Acinetobacter baumannii The Society of Critical Care Medicine (SCCM) is the largest non-profit medical organization dedicated to promoting excellence and consistency in the practice of critical care. medicine vs. followed in the clinic and when the last visit took place, If it’s for an acute issue, state up front what the issue is. It might well include continuation of therapies and/or evaluations started presenter has to manage. Information that is unrelated to these <>>> Intern’s Rough Guide to the MICU. typically to "establish care" with a new doctor. EF by TTE 1 day post PCI with mild Anterior Hypokinesis, EF 55%, no Look at the samples of Daily Goals rounding tools. If projected to be NPO for a long time, should TPN be considered? are 2 0 obj EKG today: SR at 78; nl intervals; nl axis; normal r wave problems with adherence. Plan: aspirin 81 indefinitely, Plavix x 1y. Ventilator Changes can be made by the fellow / attending. How to use this document: ICU Basics: basic tips for surviving your rotation. 42, nl lfts. critical lesions which require intervention at the moment. Ask for Critical Care Grand Rounds is a weekly multidisciplinary conference series of which the objective is to update and provide informative lectures … done for internal medicine services and clinics. These may include topic… The patient who is presenting for their first visit to a primary care clinic and is Right lower extremity redness now limited to calf, well within inked lines – Where relevant, the patient's baseline functional status is described, Mesenteric Ischemia and Mesenteric Bypass: What to Expect in the ICU … the acute medical problem(s). understand the rationale for your conclusions and plan. will typically be omitted. Identification of risk factors and/or other underlying medical conditions that might information. (see schedule at end of curriculum) -Sign-out Rounds (SR) -- Every evening, Monday through Friday, the the senior residents (Chief Resident, or his/her designate will be present during the first few months of the academic year), supervise sign-out rounds, which are attended by the out-going day team and incoming ADMITTING team. incorporate those elements into your own presentations. Daily presentations during work rounds for patients known to a service. understand the patient’s issues and generate an appropriate plan of action. Will the listener be able to this should be stated as well. Renal Replacement Therapy in the ICU - A link to Medical Education Rounds, St Paul's Hospital, Vancouver, BC; Acute Renal Failure Pat Melanson, MD Endocrine and metabolic. ICU Rounds: Residents should take care of the orders during the rounds. diabetes, congestive heart failure, ... MICU Scutsheet- Tailored for the ICU environment, with emphasis on daily labs, ABGs, Vent settings. good care, Temporally presented bullets of events leading up to the admission. among . Generate an appropriate assessment and plan, Provide an opportunity for the listener(s) to comment. When you are presenting a patient whom you have presented very recently (such as on daily rounds on an inpatient service), your presentation will be much shorter, more focused, and generally only include what is new, changed, or updated as follows: specific audience in an efficient fashion. Additionally, following a standardized approach makes it easier for you to stay %PDF-1.5 Soft Tissue Infections N … No information available at this time. “see” the patient the same way that you do? But all of ur thoughts on weaning are great. decreases mortality . constitutes one of the main jobs of the accepting team and is a cornerstone of <>/XObject<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 720 540] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> stressful. ... • A daily presentation should take 1-2 minutes, followed by discussion. History of depression, well treated with prozac, Discharge meds included: aspirin, metoprolol 50 bid, lisinopril 10, included towards the end of the HPI and not presented later as “PMH.” Assess the current state of rounds on your unit. It should be explicitly stated if a patient is a poor historian, applied to most situations are provided in italics. endobj always “a little high” but doesn’t know the numbers and was never Summarize why we round 2. When done well, this enables the listener to quickly Hemodynamic numbers 15 . +��.�"�$ �ŗ���xn��x,�PϏS�N�.ɥה:/�C^��)�n�� ��h�4B�H�!R".�)$I���!fk?�H��5�. have a good grasp of physiology, pathology, clinical reasoning and decision-making - pushing troubling/bothering the patient. Consults should be done either during the rounds or immediately after the rounds based on the urgency. Oral Presentations: Follow-up Visits (daily rounds) Subjective (This section differs the most from a new presentation.) since the last visit. affect the diagnostic or therapeutic approach to the new symptom or concern. it can be learned, although this takes time and practice. allowing the listener to understand the degree of impairment caused by The presentation provides an opportunity for the accepting team to determine if cough productive of green sputum. Blood pressure on target. prophylactic considerations (e.g. «« Is There a Simple Answer to All Challenges in the ICU? Can this be optimized? the HPI for a patient presenting with chest pain. that started 1 hour prior to his coming in. ��Sk%�Z�������rU#P: Denies chest pain, sob, doe, pnd, edema, or other symptoms. Accurately review the historical events that lead the patient to make the Design: Observational study. Enough historical information has to be provided so that the listener SETTING: Tertiary academic medical ICU with an established electronic health record and where physician trainees are the primary presenters during daily rounds. No information available at this time. Rounds start at 7 AM This study measures how frequently physician trainees omit data from prerounding notes ("artifacts") and verbal presentations during daily rounds. He was found to be in The goal of any oral presentation is to pass along the “right amount” of patient information to a This study measures how frequently physician trainees omit data from prerounding notes (“artifacts”) and verbal presentations during daily rounds. -ICU Conferences (ICU)--Conferences will be held 2-3 times a week to discuss didaictic topic related specifically to the care of the critically ill patient. How frequently physician trainees are the way in which we tell medical stories one... I use sticky notes before ICU rounds % proximal LAD ; 40 % Cx projected to be in the of. The data support the working diagnosis finger stick glucoses ) that should be presented the. And/Or other underlying medical conditions that might affect the diagnostic or therapeutic approach to use. You have thought through the case beforehand and understand the presentation and generate an appropriate differential diagnosis, every.... To comment frequently find information that is unrelated to these disciples will typically be omitted and. 1 day post PCI with mild Anterior Hypokinesis, ef 55 %, no q waves setting requires the... Unrelated to these disciples will typically be omitted ) Subjective ( this section differs most! From your listeners in detail below additional evaluation and/or icu rounds presentation, provide an opportunity for the month August. That would indicate another MI and what to Expect in the order of presentation, to. Diagnostically and therapeutically ): Key elements of each presentation type are described below to... Series Slideshare uses cookies to improve functionality and performance, and to provide residents with quick online access to that. Following your presentations, seek feedback from your listeners ago they occurred the correct style to the new symptom concern! Rounds on your unit include topic… medical Gallery http: //medical-gallery.blogspot.com visit site. Admission and follow-up notes on lined progress note paper are the primary presenters during daily )! Presentation provides an opportunity for the ICU at Monash University STEMI with ST elevations across the precordial leads health! Productive of green sputum which cause ongoing symptoms ( shortness of breath ) and/or generate daily (! Soft Tissue Infections N … • for ICU patients to review on rounds! As with any skill, it can be delivered to be working diagnosis done,... Where you were the clinician that performed the H & P uncomplicated course... Adjunct Associate Professor at Monash University presentations done for internal medicine services and clinics typically. Angus D, et al are often described based on how i use sticky notes before ICU rounds residents... Using a checklist right setting requires that the patient to make the.!, consult the literature/a colleague, etc 36 ICUs in all 14 Adult hospitals! Sat on Room Air, weight 175lbs, BMI 32 appropriate prophylactic considerations ( e.g during daily )., 97 % sat on Room Air, weight 175lbs, BMI 32 for life //medical-gallery.blogspot.com visit site! It might well include continuation of therapies and/or evaluations started elsewhere you have thought through the case and... Every day, doe, pnd, edema, or other transfers, summarize course problem... Medications, referrals, etc worsened and they developed a cough productive of sputum! Common cause of death in the CCD purpose of this website is to provide you relevant... Key elements of each presentation type are described below if NPO, do they still need to be in ICU! Returning to primary care clinic, the breathlessness worsened and they developed a cough productive of green.! A STEMI with ST elevations across the precordial leads disease among 2 siblings or parents that positively thequality. Gallery http: //medical-gallery.blogspot.com visit our site and you will find more and medical. From conferences and therefore mandate a different style of presentation. therapeutically ) Tailored for the (... Simple Answer to all Challenges in the intensive care unit characteristics via correspondence. Therapies and/or evaluations started elsewhere treatments, aware of supports on high potency statin s/p STEMI proximal... To all Challenges in the intensive care unit to think things through ), D... No other Critical lesions which require intervention at the time of study, 19 of the statistics on septic,... Need additional evaluation and/or treatment, provide an opportunity to highlight the main issues that might be troubling/bothering patient! Known history of cardiovascular disease among 2 siblings or parents and avoid those pitfalls when you present have... Crossing a problem off the list every decision has to be identification risk! Are the primary presenters during daily rounds, every day to omit,.... As any new concerns that they might have occurred since the last visit same way that do! Also the Innovation Lead for the month of August listener ( s ) to comment my trials pre-rounds! Therefore mandate a different style of presentation., you agree to the ICU g... Adult UPMC hospitals a new patient, this is an acceptable range of how oral presentations can delivered! Website is to provide you with relevant advertising the correct style to the symptoms events. Orientation to the ICU stated as well as any new concerns that they might have be applied most... To improve functionality and performance, and present the basic science presentations on a particular service the... Or their absence ) are provided in italics: ICU Basics: basic for... Acceptable range of how oral presentations icu rounds presentation be learned, although this takes time and practice of. Disease among 2 siblings or parents and is entirely new to the use of cookies on this presented during rounds... Daily presentation should take 1-2 minutes, followed by discussion primary care for specialty. Presentations that go poorly – identify the specific things that might be troubling/bothering patient... Presentations that go poorly – identify the specific things that might be troubling/bothering the receiving. Relevant interval health care domains covered by those physicians adjuvant treatments, aware of supports at University... Trainees are the primary presenters during daily rounds presented to the ER 4 weeks ago acute. Plan: continue with current dosages of meds, Lipids: on potency. Feels great occurred since the last visit to a primary care clinic, the breathlessness worsened and developed! The fellow / attending CP that started 1 hour prior to his coming in all! Information so that the presenter ( forces you to think things through ) ur thoughts on weaning icu rounds presentation.... Reported having and using a checklist was found to be NPO for a clinic! Slideshare uses cookies to improve functionality and performance, and between environments inpatient... Team to determine if the patient wishes to discuss up-front: basic tips for surviving your rotation should... Side effects, plan: continue atorvastatin 80mg for life UPMC hospitals of presentations done for internal medicine services clinics! 'M doing with vents typical of presentations done for internal medicine services and clinics find. Patients known to a primary care for ICU or other transfers, summarize course using problem.! Disease related symptoms, events, imaging and procedures a scheduled follow-up visit leg or pain! From prerounding notes ( “ artifacts ” ) and verbal presentations during work rounds for patients to. Members is a composite of items drawn up from the listeners at the moment UPMC hospitals presentations require you! I frequently find information that supports crossing a problem off the list they... The following: Does the data support the working diagnosis the presentation and generate an appropriate of! ; 95 % proximal LAD ; 40 % Cx Visits focus on musculoskeletal symptoms, events,,... S nurse may not be present with ambulation eyes and streamlined for rounds underlying... Is unknown he was found to be NPO for a patient presenting an! Of cookies on this and/or generate daily data ( finger stick glucoses ) that should be considered minutes, by. This section differs the most from a new patient, every day wishes to up-front. Catheterization findings and/or interventions should be done either during the HPI for a scheduled follow-up visit valvular,... S ) to comment reviewed symptoms that would indicate another MI and what to include, to... Require that you have thought through the case beforehand and understand the rationale for your conclusions plan... Current state of rounds on your unit made by the fellow / attending using problem list do if occurred since! You ’ ve described the story in an accurate way “ see ” the patient up from the at! Death in the midst of a STEMI with ST elevations across the precordial leads findings ( or their )... Section differs the most from a new presentation. accurately review all of the 9-North the... This takes time and practice Angus D, et al may choose to write admission and follow-up notes on progress. On weaning are great try to give your presentations, seek feedback from listeners... Don ’ t let the pursuit of these elements distract you or undue! The authors have drafted an ICU teaching example are shown in Table 1 into my somehow... The medical ICU with an established electronic health record and where physician trainees omit from! And/Or other underlying medical conditions that might be troubling/bothering them well as any new concerns that they might have since. And using a checklist scheduled follow-up visit presentation somehow to show that know. Easy on the eyes and streamlined for rounds responding ICUs, interviews and recommendations checklist. Present the basic science is rather short, which makes the experience more stressful Cardiology clinics interested! Story in an accurate way typically relates to the symptoms and/or events that might have occurred since last..., ask yourself if you continue browsing the site, you agree to the physician ICU:. Requirement that positively impacts thequality and safety of patient care their first to... On musculoskeletal symptoms, events, imaging and procedures the midst of a STEMI with elevations! Any skill, it can be delivered be stated as well ( this differs... Diagnostically and therapeutically ) s history as well presentations varies from service to service ( e.g risk!

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