Emergency Care for Pregnant Patients

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Questions and Answers

What effect does pre-treatment with calcium gluconate have on verapamil?

It increases the antiarrhythmic effect of verapamil.

It enhances the hypotensive effect of verapamil.

It reduces the hypotensive effect of verapamil but does not affect its antiarrhythmic effect. (correct)

It completely neutralizes the effects of verapamil.

When should verapamil be avoided in patients with tachycardia?

When the QRS complex is wider than 0.14 seconds. (correct)

When the patient has a known history of atrial fibrillation.

When the tachycardia is of unknown origin.

When the patient has low blood pressure.

What should be done if supraventricular tachycardia (SVT) persists after initial treatment?

Wait and monitor for further symptoms.

Continue administering high doses of verapamil.

Consider direct current (DC) cardioversion or intravenous amiodarone. (correct)

Opt for oral medication as a next step.

What is the mechanism of action of verapamil?

It blocks voltage-dependent calcium channels. Signup and view all the answers

What characteristic of the QRS complex is indicative of ventricular tachycardia?

Wide QRS complex greater than 0.12 seconds. Signup and view all the answers

What is the primary sign of non-response related to pulmonary oedema?

Failure to maintain an adequate partial pressure of oxygen (PaO2) Signup and view all the answers

In which scenario should prasugrel not be used?

Patients with previous ischaemic attack Signup and view all the answers

What is the preferred treatment option if PCI is available within 90 minutes of first medical contact?

Percutaneous coronary intervention (PCI) Signup and view all the answers

Which medication is part of the dual antiplatelet therapy regimen?

Aspirin Signup and view all the answers

What complication is commonly associated with myocardial infarction?

Stroke Signup and view all the answers

What is an effect of pain related to myocardial ischaemia?

Increased catecholamines Signup and view all the answers

What type of response can occur with the Bezold-Jarisch reflex?

Hypotensive bradycardic response Signup and view all the answers

Why should fibrinolytic agents be administered quickly in cases of STEMI?

To reduce the time for reperfusion Signup and view all the answers

Which class of heart failure correlates with mild to moderate symptoms and some lung involvement?

Class II Signup and view all the answers

Which condition can be triggered by emotional or physical stress related to a myocardial event?

Takotsubo’s cardiomyopathy Signup and view all the answers

What should be used cautiously in patients with right ventricle infarction?

Nitrates Signup and view all the answers

What is the first line of treatment for breathless or hypoxic patients?

Oxygen supply via facemask or nasal prongs Signup and view all the answers

What is the best indication for considering dobutamine in acute pulmonary oedema?

Lack of response to initial measures Signup and view all the answers

Which of the following drugs is used in combination with aspirin for dual antiplatelet therapy?

Prasugrel Signup and view all the answers

What is the primary characteristic of heart failure with reduced left ventricular ejection fraction (HFrEF)?

Pulmonary congestion Signup and view all the answers

Which of the following is a common cause of heart failure?

Coronary artery disease Signup and view all the answers

During the management of heart failure, which medication option is used for all patients?

ACE inhibitor or ARB Signup and view all the answers

In the context of acute cardiogenic pulmonary oedema, what positions should the patient ideally be in?

Sitting as upright as possible Signup and view all the answers

What is the recommended initial dose of frusemide for treating acute cardiogenic pulmonary oedema?

20-80 mg IV Signup and view all the answers

Which symptom is NOT typically associated with acute cardiogenic pulmonary oedema?

Increased blood pressure Signup and view all the answers

What additional therapy may be considered if there is an inadequate clinical response to oxygen and frusemide during treatment?

Glyceryl trinitrate Signup and view all the answers

Which of the following conditions is NOT a precipitating factor of heart failure?

Hypoglycemia Signup and view all the answers

What is one of the two major pathophysiological processes involved in acute cardiogenic pulmonary oedema?

Intra-alveolar fluid accumulation Signup and view all the answers

Which factor suggests the likelihood of a biventricular heart failure condition?

Presence of both pulmonary congestion and elevated venous pressure Signup and view all the answers

What is the recommended compression: ventilation ratio during cardiopulmonary resuscitation?

30:2 Signup and view all the answers

What should be checked before commencing chest compressions in a patient who has collapsed?

Radial pulse Signup and view all the answers

Under what condition should oxygen be administered to a patient?

If O2 saturation is below 94% or in shock Signup and view all the answers

Which of the following is a contraindication to administering aspirin?

Patient unable to chew or swallow Signup and view all the answers

What is the purpose of giving five initial rescue breaths during CPR?

To ensure adequate ventilation Signup and view all the answers

What indicates the necessity of administering glyceryl trinitrate (GTN)?

Acute cardiogenic pulmonary oedema Signup and view all the answers

Which finding would lead you to avoid using GTN in a patient with a suspected inferior myocardial infarction?

High risk of developing hypotension Signup and view all the answers

What is a common side effect of administering glyceryl trinitrate?

Dizziness Signup and view all the answers

What is true regarding cardiac biomarkers in chest pain evaluation?

Troponin levels remain elevated for 7-10 days after an MI Signup and view all the answers

In which situation should a standard 12-lead ECG be obtained?

For all patients presenting to the emergency department with chest pain Signup and view all the answers

What is a primary investigation for acute myocardial infarction in chest pain patients?

12-lead electrocardiogram Signup and view all the answers

Which symptom typically indicates the need for immediate medical attention and possible myocardial infarction?

Sharp central chest pain Signup and view all the answers

What is a key factor in deciding the urgency of intervention in a patient presenting with chest pain?

Duration of chest pain Signup and view all the answers

Which of the following conditions is NOT a top concern to rule out in a patient with chest pain?

Dehydration Signup and view all the answers

What is the default energy level for biphasic shocks in adults?

200 J Signup and view all the answers

What should be avoided when using defibrillator pads?

Placing pads over ECG electrodes Signup and view all the answers

What is the recommended compression to ventilation ratio during CPR?

30:2 Signup and view all the answers

What is an important safety precaution when delivering a defibrillation shock?

Make sure the pads are well attached Signup and view all the answers

When might the intraosseous route be considered?

If venous access is not immediately available Signup and view all the answers

What is a potential hazard if the victim is in contact with metal fixtures during defibrillation?

Shock transmission risk Signup and view all the answers

What is a recommended practice after delivering a tidal breath during CPR?

Delivering a tidal volume that results in visible chest rise Signup and view all the answers

Why is the precordial thump no longer recommended for ventricular fibrillation?

It can cause additional injuries Signup and view all the answers

In what situation may mechanical devices like LUCAS be recommended?

In circumstances making manual CPR difficult or hazardous Signup and view all the answers

What is a significant risk when someone is in direct contact with the victim during defibrillation?

Possibility of receiving a shock themselves Signup and view all the answers

Study Notes

Defibrillation Guidelines

Pregnant women should be positioned to relieve pressure from the uterus on abdomen blood vessels during defibrillation.
Defibrillator pads must not be placed over ECG electrodes due to burn and spark risks.
Ensure no direct or indirect contact with the victim during defibrillation to avoid shock hazards.
Avoid placing the victim against metal fixtures or leaving a gap between the pads and chest wall during shock delivery.

Advanced Life Support

Precordial thump is not recommended for ventricular fibrillation.
Intraosseous access should be used for medication delivery if venous access is unavailable.
Mechanical devices like LUCAS may be beneficial when manual CPR is impractical.
Recommended compression to ventilation ratio is 30:2, with initial rescue breaths delivered within one second.
Verify radial pulse prior to starting chest compressions; do not commence CPR if breathing is irregular or abnormal.

Chest Pain Assessment

Top diagnoses to rule out for chest pain include acute coronary syndrome, aortic dissection, pulmonary embolism, tension pneumothorax, and pericardial tamponade.
Oxygen therapy is justified only if oxygen saturation falls below 94% or if the patient is in shock.
MONA (Morphine, Oxygen, Nitroglycerin, Aspirin) protocol used for chest pain management; aspirin should be chewed or dissolved.

Glyceryl Trinitrate (GTN) Usage

GTN is used to treat acute cardiogenic pulmonary edema and autonomic dysreflexia under specific blood pressure conditions.
Caution in administering GTN for suspected inferior MI due to hypotension risks.
Side effects of GTN include dizziness, hypotension, syncope, reflex tachycardia, and vascular headaches.

Diagnostic Procedures for Chest Pain

Obtain a 12-lead ECG within 10 minutes of presentation; sensitivity for acute MI is low.
Cardiac biomarker tests (Troponins I and T) must be repeated for accuracy; an early negative troponin does not exclude myocardial ischemia.
CK-MB levels are no longer recommended due to lower relevance.

Heart Failure Overview

Heart failure can be classified as either left-sided or right-sided; HFrEF is marked by reduced left ventricular ejection fraction (40% or less).
Causes include hypertension, coronary artery disease, diabetes, arrhythmias, and excessive alcohol intake.
Precipitating factors for heart failure include poor medication adherence, fluid overload, and myocardial ischemia.

Management of Acute Cardiogenic Pulmonary Oedema

Patients should be seated upright; severe dyspnea can occur suddenly, often at night.
Rapid treatment with IV or IM frusemide (20-80 mg) is crucial, with adjustments for ongoing symptoms.
Oxygen therapy is indicated if saturation drops below 94%, using a high-flow mask to optimize delivery.
Severe cases may require further measures, including urinary monitoring or intravenous GTN infusion; intubation is a last resort if no improvement is seen.### Signs of Non-Response in Emergency Care
Non-response indicators include patient exhaustion and declining level of consciousness.
Increasing confusion and agitation can signal distress in pulmonary conditions.
Rising carbon dioxide partial pressure (PaCO2) and failure to maintain adequate oxygen partial pressure (PaO2) are critical signs.
In cases of acute pulmonary edema not responding to initial measures, consider adding dobutamine and administering 100% oxygen via CPAP.

STEMI Management Considerations

Prasugrel is contraindicated for patients weighing less than 65 kg, those aged 75 or older, or individuals with a history of ischaemic attack.
Dual antiplatelet therapy involves aspirin combined with a P2Y12 inhibitor (Clopidogrel, Ticagrelor, or Prasugrel).

Acute Management Strategies

Key initial interventions include cardiac monitoring with oxygen, ECG, aspirin, and sublingual nitroglycerin.
Effective pain relief is crucial to reduce catecholamine release, which can exacerbate ischaemia.
Reperfusion therapy should be initiated within 5 minutes of arrival; fibrinolytic agents typically require 30-45 minutes to act.

Reperfusion Therapy Options

Percutaneous Coronary Intervention (PCI) is preferred over fibrinolytic therapy if available within 90 minutes of first medical contact.
Fibrinolytic therapy is indicated if PCI cannot be performed promptly and should be given within 30 minutes.
Complications of myocardial infarction (MI) include arrhythmias and postinfarction angina.

Inferior Myocardial Infarction Considerations

Right ventricle infarction may complicate inferior MI and is highly preload sensitive, necessitating caution with nitrates.
Severity classifications range from Class I (no failure) to Class IV (cardiogenic shock), indicating different levels of heart failure.

Takotsubo’s Cardiomyopathy

Triggered by emotional or physical stress, it may present like acute coronary syndrome.

Antiarrhythmic Treatment Protocols

In cases of stable ventricular tachycardia, administer Metoprolol tartrate intravenously. Further doses may be given if well tolerated.
If supraventricular tachycardia (SVT) persists, consider direct current cardioversion or intravenous amiodarone.
Avoid verapamil in wide-complex tachycardia unless supraventricular origin is confirmed.

Key ECG Features for SVT

Typical ECG findings in SVT may include narrow QRS complexes, indicating a tachyarrhythmia of supraventricular origin.

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Description

This quiz covers important aspects of emergency care for pregnant women, specifically focusing on the correct positioning and defibrillation techniques. Understanding the unique physiological changes in pregnancy is crucial for effective medical response during emergencies. Prepare to test your knowledge on managing high-risk situations involving pregnant patients.