STEMI Treatment and Care Quiz
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Questions and Answers

What is the primary purpose of Primary PCI in the treatment of STEMI?

  • To initiate early rehabilitation post-MI
  • To provide chronic care management
  • To diagnose heart conditions
  • To restore blood flow in a timely manner (correct)

Which factor is identified as a significant barrier to improved care for STEMI patients?

  • Inefficient systems leading to delays (correct)
  • Insufficient training for medical personnel
  • High costs of reperfusion therapy
  • Excessive focus on triaging patients

Which of the following is NOT a component of the 'chain of survival' for STEMI?

  • Coordination of destination protocols
  • Expeditious implementation of reperfusion
  • Accurate diagnosis through imaging (correct)
  • Patient education about symptoms

What role does the American Heart Association play in the care of STEMI?

<p>To maintain a national initiative for better delivery of care (C)</p> Signup and view all the answers

What is a requirement for a system of care for STEMI according to the established criteria?

<p>Registration with Mission: Lifeline (C)</p> Signup and view all the answers

Which intervention is aimed at improving door-to-device times for STEMI patients?

<p>Prehospital identification and activation processes (C)</p> Signup and view all the answers

What should a STEMI system coordinator ideally be responsible for?

<p>Coordinating multidisciplinary team meetings (A)</p> Signup and view all the answers

Why is minimizing delays in reperfusion crucial for STEMI patients?

<p>It improves overall chances of survival and heart function (C)</p> Signup and view all the answers

What is the primary purpose of a prehospital ECG for diagnosing STEMI?

<p>To activate the PCI team while the patient is en route to the hospital (B)</p> Signup and view all the answers

What is the goal time for the PCI team to arrive at the catheterization laboratory after being paged?

<p>20 minutes (D)</p> Signup and view all the answers

Which patient-related factor may correlate with a longer delay in seeking medical attention for STEMI?

<p>Uninsured status (D)</p> Signup and view all the answers

What is one of the major components of time from symptom onset to reperfusion?

<p>Time to recognize the problem and seek medical attention (B)</p> Signup and view all the answers

Which of the following is critical for the survival of patients with STEMI?

<p>Immediate implementation of resuscitative efforts (C)</p> Signup and view all the answers

What should healthcare professionals do for patients at risk of STEMI during elective encounters?

<p>Review and reinforce the need for urgent medical attention for specific symptoms (C)</p> Signup and view all the answers

Most deaths associated with STEMI occur within which timeframe after its onset?

<p>First hour (A)</p> Signup and view all the answers

Which is NOT a classification of reperfusion strategies mentioned?

<p>Emergency surgery time (B)</p> Signup and view all the answers

What should patients do if ischemic-type discomfort persists for more than 5 minutes?

<p>Call emergency services (D)</p> Signup and view all the answers

What is one major advance in Emergency Medical Service (EMS) systems?

<p>Ability to record a prehospital 12-lead ECG (A)</p> Signup and view all the answers

What is the primary goal of the STEMI care system?

<p>Maintain total ischemic time to less than 120 minutes (D)</p> Signup and view all the answers

What must occur if EMS has fibrinolytic capability and the patient qualifies for therapy?

<p>Prehospital fibrinolysis should be considered within 30 minutes of arrival (A)</p> Signup and view all the answers

What should be the maximum door-to-needle time for hospitals administering fibrinolytic therapy?

<p>30 minutes or less (D)</p> Signup and view all the answers

What is discouraged for patients experiencing ischemic symptoms?

<p>Self-transportation to the hospital (B)</p> Signup and view all the answers

What is the recommended FMC-to-device time for patients transported to a PCI-capable hospital?

<p>90 minutes or less (B)</p> Signup and view all the answers

What is a key component that enhances the EMS response to STEMI patients?

<p>Greater coordination of the EMS ambulance response (A)</p> Signup and view all the answers

What has been a significant change in the management of ST-elevation myocardial infarction (STEMI)?

<p>Shift from pharmacologic to catheter-based reperfusion strategies. (D)</p> Signup and view all the answers

What is crucial for the management of patients with established major complications of STEMI?

<p>Optimal management of high-risk patients. (C)</p> Signup and view all the answers

Which chapter addresses percutaneous coronary intervention (PCI) in patients with STEMI?

<p>Chapter 41 (D)</p> Signup and view all the answers

The decline in early mortality rates among STEMI patients from 1986 to 2018 has been attributed to what?

<p>Improvements in pharmacologic and mechanical reperfusion therapy. (B)</p> Signup and view all the answers

What is the primary goal of initial management for STEMI patients?

<p>To restore blood flow to the infarct zone as rapidly as possible. (A)</p> Signup and view all the answers

Which medication is typically involved in the treatment of STEMI during reperfusion therapy?

<p>Streptokinase (A)</p> Signup and view all the answers

What does Chapter 40 focus on in relation to coronary artery disease (CAD)?

<p>Long-term management of patients with stable ischemic heart disease. (D)</p> Signup and view all the answers

What does the presence of persistent occlusion in the infarct-related artery lead to in STEMI patients?

<p>Progressive loss of functioning myocytes. (A)</p> Signup and view all the answers

What percentage reduction in mortality was demonstrated through a meta-analysis of all available trials for prehospital fibrinolysis?

<p>17% (D)</p> Signup and view all the answers

In the STREAM trial, what was the primary endpoint measured at 30 days?

<p>Death, shock, heart failure, or reinfarction (C)</p> Signup and view all the answers

What was the percentage of patients in the fibrinolysis arm who required rescue or urgent PCI?

<p>36% (D)</p> Signup and view all the answers

What was the rate of intracranial hemorrhage in the fibrinolysis group compared to the primary PCI group?

<p>1.0% versus 0.2% (B)</p> Signup and view all the answers

What is generally considered a reasonable condition for the administration of prehospital fibrinolysis?

<p>Long transportation times and physician presence in the ambulance (C)</p> Signup and view all the answers

In the STREAM trial, which group had a lower percentage of the primary endpoint occurring at 30 days?

<p>Fibrinolysis arm (A)</p> Signup and view all the answers

What is the main comparison made in the STREAM trial?

<p>Prehospital fibrinolysis versus primary PCI (B)</p> Signup and view all the answers

What time frame defines the patients included in the STREAM trial regarding symptom onset?

<p>Within 3 hours (C)</p> Signup and view all the answers

What is the primary tool used for screening patients with possible acute coronary syndrome for STEMI?

<p>12-lead ECG (B)</p> Signup and view all the answers

What is the recommended time frame for obtaining a 12-lead ECG in patients with suspected ischemic symptoms?

<p>Within 10 minutes (A)</p> Signup and view all the answers

Which symptom suggests thrombotic occlusion of an epicardial coronary artery?

<p>ST-segment elevation (B)</p> Signup and view all the answers

Which factor is NOT critical in selecting a reperfusion strategy for STEMI?

<p>Patient's age (B)</p> Signup and view all the answers

What should be monitored in all patients with STEMI due to the risk of lethal arrhythmias?

<p>Bedside ECG (C)</p> Signup and view all the answers

In which scenario would a patient not be considered for immediate reperfusion therapy?

<p>ST-segment depression or T wave inversion (B)</p> Signup and view all the answers

What is an important evaluation for patients in non-PCI-capable hospitals regarding fibrinolytics?

<p>Contraindications to treatment (C)</p> Signup and view all the answers

What is the purpose of more extensive use of prehospital 12-lead ECGs?

<p>To assist in early triage of STEMI patients (C)</p> Signup and view all the answers

Flashcards

Primary PCI

A treatment for a heart attack involving opening a blocked artery using a catheter and stent.

Door-to-device time

The time taken from a patient's arrival at the emergency department to the start of a heart attack treatment.

Chain of Survival for STEMI

A system of care designed to improve the outcomes for patients experiencing a heart attack.

Destination protocols

A healthcare strategy that focuses on getting a patient to a hospital capable of performing a heart attack procedure, like PCI.

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Multidisciplinary team

A team of healthcare professionals working together to improve the care of patients with a heart attack.

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Fibrinolytic therapy

A method of opening a blocked artery using medication injected directly into the blood vessels.

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Cardiogenic shock

A serious medical condition where the heart is not pumping enough blood to the body.

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System of care for STEMI

A system of care where prehospital identification, destination protocols, transfer procedures, and trained teams work together to deliver timely and effective care for a heart attack.

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What is STEMI?

A type of heart attack where a major artery in the heart is completely blocked, causing damage to the heart muscle.

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What is Percutaneous Coronary Intervention (PCI)?

A medical procedure that uses a catheter to open a blocked artery in the heart. It's the primary treatment for STEMI.

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What is the main goal of STEMI treatment?

The goal of STEMI treatment is to quickly restore blood flow to the affected area of the heart. This can be achieved through medications or PCI.

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What is reperfusion therapy?

The use of medications or procedures to restore blood flow to the heart after a heart attack.

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What is case-fatality rate?

The rate at which people die from a specific condition, like STEMI.

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What are some medications used in STEMI treatment?

The medications used to treat STEMI aim to prevent blood clots from forming, open up blocked arteries, and protect the heart muscle.

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What is secondary prevention in STEMI?

This refers to the steps taken to prevent further heart problems after a STEMI, such as lifestyle changes and medication.

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What is prehospital management of STEMI?

The initial care provided to a STEMI patient before they reach the hospital.

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What's the goal of prehospital care for STEMI?

Prehospital care focuses on activating the PCI team quickly and getting the patient to the hospital rapidly for prompt treatment.

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What factors contribute to the time from STEMI symptom onset to reperfusion?

Time from symptom onset to restoration of blood flow is crucial for survival in STEMI.

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What is the major cause of death within the first hour of STEMI onset?

Ventricular fibrillation is a major cause of death in STEMI, usually within the first hour of symptom onset.

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Which patient factors might lead to a longer delay in seeking medical attention for STEMI?

Patients with older age, female sex, black race, low socioeconomic status, history of angina or diabetes, and consulting a spouse or physician tend to have longer delays in seeking medical attention for STEMI.

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How can healthcare professionals improve STEMI awareness and response?

Health professionals should educate patients about the importance of urgent medical attention for chest discomfort or dyspnea, especially those with risk factors like hypertension, diabetes, or history of angina.

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What is PCI?

Percutaneous coronary intervention (PCI) is a procedure that uses a catheter to open a blocked coronary artery.

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What is the target time for PCI team arrival at the cath lab?

The goal for PCI team arrival at the catheterization laboratory is within 20 minutes after being paged.

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Door-to-balloon Time (D2B)

The time from arrival at the ED to the start of PCI, aiming to be under 90 minutes.

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What is the System of Care for STEMI?

A system of care including prehospital identification, transport protocols, and trained teams, aiming to deliver timely and effective care for a heart attack.

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Prehospital Fibrinolysis

Prehospital fibrinolysis involves administering clot-busting medication (fibrinolytics) in an ambulance to dissolve the blood clot blocking a coronary artery in the heart, starting treatment sooner and potentially improving outcomes for patients with STEMI.

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When is Prehospital Fibrinolysis Useful?

Prehospital fibrinolysis is a reasonable treatment strategy when there is a long time between the call for help and reaching the hospital, typically 60-90 minutes or longer.

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STREAM Trial Findings

The STREAM trial demonstrated that prehospital fibrinolysis could be as effective as primary PCI for patients experiencing STEMI who arrive within 3 hours of symptoms onset and can't undergo primary PCI within 1 hour of initial contact.

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Potential Risks of Prehospital Fibrinolysis

Prehospital fibrinolysis can sometimes lead to a higher rate of intracranial hemorrhage (bleeding in the brain) compared to primary PCI. However, non-intracranial bleeding rates were similar between the groups.

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Requirements for Successful Prehospital Fibrinolysis

Prehospital fibrinolysis requires properly trained paramedic professionals with access to essential tools, like 12-lead ECG recording and online medical command, to ensure effective diagnosis and treatment.

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Rescue PCI in Prehospital Fibrinolysis

Rescue PCI may be needed for patients who received prehospital fibrinolysis, if the blood clot doesn't dissolve completely or further interventions are necessary.

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Factors Influencing Prehospital Fibrinolysis Use

The decision to use prehospital fibrinolysis depends on factors like transportation time, patient's location, and access to appropriate medical personnel and equipment.

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Prehospital Fibrinolysis as a Part of a System

Prehospital fibrinolysis requires a well-coordinated EMS system with trained personnel and capabilities to deliver timely and effective treatment before reaching the hospital.

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