Acute Coronary Syndrome (ACS) and ST-Segment Elevation Myocardial Infarction (STEMI)
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Questions and Answers

When should you consider IO access in an advanced airway scenario?

  • When IV access is readily available
  • Only in pediatric patients
  • If attempts at IV access are unsuccessful or not feasible (correct)
  • In all cardiac arrest patients
  • What is the recommended rate for PPV in adult patients?

  • 20 BPM
  • 15 BPM
  • 12 BPM
  • 10 BPM (correct)
  • What is the indication for administering aspirin 324mg in a patient with suspected ACS?

  • Cardiac ischemia regardless of chest pain (correct)
  • Confirmed adequate dose taken after symptom onset
  • PMH of AMI, PCI/stent/CABG
  • Chest pain after trauma
  • What is the maximum dose of epinephrine for pediatric patients?

    <p>1 mg</p> Signup and view all the answers

    When should the 12-L ECG be performed in a patient with suspected ACS?

    <p>Within 5 minutes of patient contact</p> Signup and view all the answers

    When should you give medications in an advanced airway scenario?

    <p>Without CPR interruption</p> Signup and view all the answers

    What is the primary contraindication for administering aspirin 324mg?

    <p>Chest pain after trauma</p> Signup and view all the answers

    What is the recommended position of the head of the bed when using a CPR device?

    <p>Flat</p> Signup and view all the answers

    What is the indication for NS TKO?

    <p>IVF indicated per condition</p> Signup and view all the answers

    How often should the 12-L ECG be repeated if the patient has ongoing pain or symptoms?

    <p>Every 10 minutes</p> Signup and view all the answers

    What is the initial dose of nitroglycerin administered sublingually in a patient with ACS?

    <p>0.4 mg</p> Signup and view all the answers

    What is the purpose of transmitting the 12-L ECG tracing to the receiving hospital?

    <p>To provide the receiving hospital with a complete picture of the patient's condition</p> Signup and view all the answers

    What is the systolic blood pressure threshold for administering nitroglycerin in a patient with ACS?

    <p>SBP &gt; 100</p> Signup and view all the answers

    When should the STEMI alert be called?

    <p>When the 12-L ECG shows positive changes</p> Signup and view all the answers

    Which of the following comorbidities is NOT typically considered when obtaining a patient's PMH in the context of heart failure?

    <p>Chronic kidney disease</p> Signup and view all the answers

    What is the primary purpose of assessing lung sounds in all lobes, front and back, in a patient with suspected heart failure?

    <p>To assess for clinical congestion</p> Signup and view all the answers

    In a patient with pulmonary edema, what is the recommended initial PEEP setting for C-PAP?

    <p>5-10 cm PEEP</p> Signup and view all the answers

    What is the recommended dose of aspirin in the context of ACS SOP?

    <p>324 mg PO</p> Signup and view all the answers

    What is the recommended frequency of repeating nitroglycerin 0.4 mg SL in a patient with pulmonary edema?

    <p>Every 3-5 minutes</p> Signup and view all the answers

    What is the primary indication for considering ADV airway in a patient with pulmonary edema?

    <p>Respiratory distress and CPAP contraindication</p> Signup and view all the answers

    What should you do if the cardiac monitor senses a native rhythm with CPR in progress?

    <p>Continue compressions without interrupting</p> Signup and view all the answers

    What is the recommended joule dosage for pediatric patients weighing less than 50 kg?

    <p>2 J/kg, then 4 J/kg, then ≥ 4 J/kg not to exceed 10 J/kg or adult max</p> Signup and view all the answers

    What should you do during a perishock pause when using a CPR device?

    <p>Do not pause compressions</p> Signup and view all the answers

    When should you check for a pulse or rhythm during CPR?

    <p>After 2 minutes of CPR</p> Signup and view all the answers

    What is the recommended action if the patient has very fine VF and/or EtCO2 is low or decreasing?

    <p>Attempt to improve perfusion and ventilation</p> Signup and view all the answers

    What is the priority order for ALS interventions?

    <p>IV/IO access, epinephrine, advanced airway</p> Signup and view all the answers

    What should you do if you are unable to identify a rhythm during CPR?

    <p>Print a strip during the pause, resume compressions, and read the ECG from the printed strip</p> Signup and view all the answers

    What should you do if you are using a CPR device without a cardiac monitor?

    <p>Palpate the femoral pulse for 5 seconds with compressions in progress</p> Signup and view all the answers

    What is a typical symptom associated with an acute coronary syndrome (ACS)?

    <p>Pain or discomfort in the chest</p> Signup and view all the answers

    Which populations are likely to present with atypical symptoms of acute coronary syndrome?

    <p>Elderly, women, and diabetics</p> Signup and view all the answers

    When should aspirin (ASA) and nitroglycerin (NTG) be deferred in management of a patient with ACS?

    <p>In patients with recent thoracic trauma or surgery within the last 72 hours</p> Signup and view all the answers

    What is the primary goal in the immediate management of a suspected STEMI patient?

    <p>Decrease oxygen demand and limit activity</p> Signup and view all the answers

    What SpO2 level should be targeted when titrating oxygen in patients showing dyspnea or signs of heart failure?

    <p>94%</p> Signup and view all the answers

    Which medication history should be specifically obtained in patients with suspected cardiac issues?

    <p>Beta or calcium channel blockers and anticoagulants</p> Signup and view all the answers

    Study Notes

    Acute Coronary Syndrome (ACS)

    • Typical symptoms: pain, discomfort, or tightness in the chest, neck, jaw, teeth, back, arm, or abdomen of suspected cardiac origin
    • May also present with dyspnea, sweating, nausea, vomiting, dizziness, fatigue, or weakness and may be associated with presyncope, syncope, acute HF, or shock = medical emergency
    • Atypical symptoms may be seen in elderly, women, diabetics, and those with recent thoracic surgery or trauma

    Initial Management of Chest Pain (IMC)

    • Begin immediate IMC
    • Decrease O2 demand: limit activity, do not allow to walk, sit up, loosen tight clothing
    • If dyspnea, hypoxemia, or obvious signs of HF, titrate O2 to achieve SpO2 of 94%
    • Cardiac monitor: assess for rate, rhythm, pump, or volume problem; hypoperfusion & CR compromise
    • Rx per appropriate SOP
    • Obtain medication Hx: Is pt taking beta-or calcium channel blockers, clonidine, digoxin, anticoagulants, or meds for erectile dysfunction or pulmonary HTN (vasodilators)

    Aspirin Administration

    • Indication: Cardiac ischemia due to suspected ACS regardless of chest pain
    • Contraindications: Drug appendix + confirmed adequate dose taken after symptom onset; chest pain after trauma
    • Dosage: 324 mg (4 tabs 81 mg) chewed and swallowed while prepping for 12-L ECG

    12-Lead ECG

    • Perform within 5 min of pt contact
    • Ensure good skin prep & interface | Correct lead placement
    • Clear tracing w/o artifact: capture while stationary - may transmit while moving
    • Call STEMI alert ASAP if + 12 L ECG changes present
    • Communicate & document: Clinical S&S (OPQRST), Pt age, gender, DNR status, PCP/cardiologist if known, Meds, PMH of AMI, PCI/stent/CABG, chronic kidney disease, or contrast allergy (GWTG)

    Nitroglycerin Administration

    • Dosage: 0.4 mg SL [BLS] unless contraindicated – see drug appendix
    • Repeat NTG 0.4 mg SL every 3-5 min X 2; monitor for SE [BLS]
    • Pain persists | SBP ≥90 (MAP ≥65) after NTG or NTG contraindicated: Rx per PAIN Mgt.SOP

    Early Defibrillation

    • Apply defib pads on exposed chest w/o interrupting compressions (anterolateral or anteroposterior)
    • Connect to cardiac monitor [ALS] / AED [BLS] (See Peds IMC p. 72 for peds pad sizes)
    • RHYTHM: Does monitor sense native rhythm with CPR in progress?
    • Joules: Monitor-specific joules (see bottom of next page)
    • Defibrillation caveats: Perishock pause, NO CPR device, NO rhythm/pulse check until after 2 min of CPR unless evidence of ROSC, Continue to defibrillate shockable rhythms per above procedure in 2-minute cycles

    Advanced Life Support (ALS) Interventions

    • Priority order: IV/IO access | EPINEPHRINE | Adv.airway
    • Vascular access: May consider IO (approved site) if attempts at IV access are unsuccessful or not feasible
    • Early EPINEPHRINE: Non-shockable rhythm: as soon as feasible | Shockable: after initial defibs
    • EPINEPHRINE dosage: Adult: 1 mg (each dose), Peds: 0.01 mg/kg (0.1 mL/kg) (max 1 mg/dose)
    • PPV: O2 15 L/BVM at 10 BPM with continuous chest compressions

    Pulmonary Edema

    • IMC special considerations:
      • Position patient sitting upright at 90˚ (if tolerated); dangle legs over sides of stretcher
      • C-PAP 5-10 cm PEEP | If SBP < 90 (MAP < 65): Titrate PEEP down to 5 cm; remove if MAP < 60
      • If resp.distress & CPAP contraindicated/not tolerated: Assess need for ADV airway [ALS]; O2 15 L/NRM
    • Nitroglycerin administration: 0.4 mg SL | If SBP ≥ 90 (MAP ≥ 65): Repeat NTG 0.4 mg SL q. 3-5 min – no dose limit

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    Description

    This quiz covers the signs and symptoms of Acute Coronary Syndrome (ACS) and ST-Segment Elevation Myocardial Infarction (STEMI), including chest pain and discomfort in the chest, neck, jaw, and other areas.

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