ACS + Cardiac Rhythm ECG + ALS

Question 1

What is CHD?

Answer 1

Coronary Heart Disease is the progressive obstruction of blood flow through coronary arteries as a result of atherosclerosis plaque build up

Question 2

What does Acute Coronary Syndrome consist of:

Answer 2

Unstable Angina
Non-ST Segment Elevation MI
ST-segment Elevation MI

Question 3

Sign and symptom of Angina

Answer 3

Retrosternal pain radiating to shoulder, arm, neck and jaw
SOB
Tachycardia
Anxiety
Cold and clammy

Question 4

What is unstable angina?

Answer 4

When Angina pain has increased in severity/duration, onset with low exertion and pain is unrelieved by GTN

Question 5

What is Myocardial Infarction?

Answer 5

Irreversible myocardial necrosis from blockage of coronary artery
Oxygen starved heart muscle

Question 6

Diagnosis of Acute MI

Answer 6

• ischaemic symptoms >30min (shoulder neck arm pain, tachycardia, cold and clammy, sweating, SOB, N&V, anxiety panic
• Diagnostic ECG change
• Troponin level elevation

Question 7

What is the acute management of ACS

Answer 7

MORPHINE / ANALGESIA
OXYGEN
NITROGLYCERIN SPRAY
ASPIRIN 300MG TABLET

Question 8

Positioning of ECG

Answer 8

RA, LA, RL, LL
V1. 4th intercostal space right of sternum
V2. 4th intercostal space left of sternum
V3. Between v2 and v4
V4. 5th intercostal space midclavicular space
V5. In level with V4 at left anterior axillary line
V6. In level with V5 left midaxillary line ( under armpit )

Question 9

What are two main shockable rhythm ?

Answer 9

Ventricular fibrillation
Ventricular tachycardia

Question 10

What are two non-shockable rhythm?

Answer 10

Asystole and Pulseless electrical activity (PEA)

Question 11

Where are adhesive de-fib pads placed on body

Answer 11

1. Below right clavicle
2. V6 left mid axillary line

Question 12

Two medication used during cardiac arrest?

Answer 12

Adrenaline and Amiodarone

Question 13

When is Adrenaline and Amiodarone administered during shockable rhythm?

Answer 13

Adrenaline 1mg IV given after second shock
Amiodarone 300mg IV with 5% dextrose after any third shock

Adrenaline given after 2nd, 4th, 6th shock

Question 14

When is adrenaline and Amiodarone administered during Non shockable rhythm?

Answer 14

Adrenaline 1mg IV given with cpr during first loop
Then Given at 3rd, 5th, 7th loop after rhythm check

Question 15

What does Waveform capnography signify in cardiac arrest?

Answer 15

End tidal co2 is the partial pressure of co2 at end of exhaled breaths

Co2 of 35-45mmHg indicate return of ROSC

Question 16

How deep should chest compression be?

Answer 16

5cm in adults - 1/3 depth AP of chest

Question 17

What are the 4 H and 4 T ?

Answer 17

Hypoxia
Hypovolaemia
Hyperkalaemia (K+ >6.5mmol)
Hypothermia

Thrombosis
Tension pneumothorax
Tamponade (compressed heart from fluid)
Toxins

Question 18

What needs to be considered during a resuscitation of a pregnant woman?

Answer 18

Place a towel/wedge under right hip to tilt the hip 15-30 degrees to the left
This helps to displace uterus and relieve pressure on inferior vena cava increasing venous return to heart

Question 19

Bag valve mask technique

Answer 19

Attach bag valve mask to wall oxygen and provide 15L/min