Cardiac Ischemia Medical Directive

Question 1

Cardiac Ischemia MD

What are the indications for the cardiac ischemia MD?

Answer 1

Suspected cardiac ischemia.

Question 2

Cardiac Ischemia MD

What are the conditions for ASA administration?

Answer 2

Age: ≥18 years
LOA: Unaltered
Other: Able to chew and swallow

Question 3

Cardiac Ischemia MD

What are the conditions for nitro administration?

Answer 3

Age: ≥18 years
LOA: Unaltered
HR: 60-159 bpm
SBP: Normotension
Other: Prior history of nitroglycerin use OR IV access obtained.

Question 4

Cardiac Ischemia MD

What are the contraindications to ASA administration?

Answer 4

Allergy or sensitivity to NSAIDs.
If asthmatic, no prior use of ASA.
Current active bleeding.
CVA or TBI in the previous 24 hours.

Question 5

Cardiac Ischemia MD

What are the contraindications to nitro administration?

Answer 5

Allergy or sensitivity to nitrates.
Phosphodiesterase inhibitor use within the previous 48 hours.
SBP drops by one-third or more of its initial value after nitroglycerin is administered.
12-lead ECG compatible with Right Ventricular MI.

Question 6

Cardiac Ischemia MD

What is the dosing information for ASA?

Answer 6

Route: PO
Dose: 160-162 mg
Max 1 dose.

Question 7

Cardiac Ischemia MD

What is the Non-STEMI nitro dosing information?

Answer 7

SBP: ≥100 mmHg
Route: SL
Dose: 0.3 mg OR 0.4 mg
Dosing interval: 5 min
Max # of doses: 6

Question 8

Cardiac Ischemia MD

What is the STEMI positive nitro dosing information?

Answer 8

SBP: ≥100 mmHg
Route: SL
Dose: 0.3 mg OR 0.4 mg
Dosing interval: 5 min
Max # of dose: 3

Question 9

Cardiac Ischemia MD

What is the goal for time to 12-lead ECG from first medical contact?

Answer 9

<10 minutes where possible.

Question 10

Cardiac Ischemia MD

What should be applied when a STEMI is identified?

Answer 10

Defibrillation pads.