Cardiac Ischemia + Cardiogenic Shock AUXILIARY + STEM hospital bypass Flashcards
Cardiac Ischemia Medical Directive
What are the INDICATIONS?
What are the top signs/symptoms?
Suspected cardiac ischemia
Neck, jaw, Shoulder, arm pain
Tachy
SOB when you are physically active
Nausea and vomiting
Sweating
Cardiac Ischemia Medical Directive
What are the CONDITIONS for ASA?
What does ASA stand for/what does it do?
What are the CONTRAINDICATIONS?
Pt has to be GREATER/EQUAL to 18y/o
Pt has to have an unaltered LOA
Pt has to be able to chew and swallow
Acetylsalicylic acid (aspririn) - is an antiplatelet NSAID - clotting
Allergy or sensitivity to NSAIDs
If pt is asthmatic AND no prior use of ASA
Current active bleeding
CVA or TBI in the pervious 24h
Cardiac Ischemia Medical Directive
What are the CONDITIONS for Nitroglycerin?
What is it/What does it do?
What are the CONTRAINDICATIONS?
Pt has to be GREATER?EQUAL to 18y/o
AND
Have an LOA unaltered
AND
HR has to be between 60-159bpm
AND
Pt’s SBP has to be normotension
AND
Pt has to have prior hx of nitroglycerin use OR IV access obtained
It’s a vasodilator that relaxes blood vessels to promote blood flow
Allergy or sensitivity to nitrates
Phosphodiesterase inhibitor use within previous 48h
SBP drops by 1/3rd (or more) of its initial value after nitroglycerin is administered
12-lead ECG compatible with right ventricular MI
Cardiac Ischemia Medical Directive
What is the ROUTE and TREATMENT PLAN for ASA?
Is there a TREATMENT PLAN for 12-lead ECG acquisition and interpretation
What is the order of TREATMENT PLANS in this medical directive?
Route - PO
Dose - 160mg-162mg
Max.Single Dose - 162mg
Dosing Interval - N/A
Max. # of doses - 1
Yes Consider doing a 12-lead to look for a STEMI BEFORE nitro
ASA - 12-Lead - Nitroglycerin
Cardiac Ischemia Medical Directive
What is the ROUTE , SBP, and TREATMENT PLAN of nitroglycerin for a pt with no STEMI?
Can you administer nitroglycerin to pts with a right ventricular MI?
What is the ROUTE , SBP, and TREATMENT PLAN of nitroglycerin for a pt with a STEMI?
Route - SL
SBP - GREATER/EQUAL than 100mHg
Dose - 0.3mg OR 0.4mg
Max.Single Dose - 0.4mg
Dosing Interval - 5min
Max. # of doses - 6
FUCK NO
Route - PO
SBP - GREATER/EQUAL than 100mmHg
Dose - 0.3mg OR 0.4mg
Max.Single Dose - 0.4mg
Dosing Interval - 5min
Max. # of doses - 3
Cardiac Ischemia Medical Directive - Clinical Considerations
What should you suspect and do in all inferior STEMIs?
Who does IV condition apply to?
What should you do for he pt when a STEMI is identified?
A right ventricular MI
Perform at minimum V4R to confirm (ST-elevation is ≥ 1mm in V4R)
PCPs authorized for PCP Autonomous IV.
Apply the defibrillation pads
Cardiac Ischemia Medical Directive - Clinical Considerations
What is the time goal to get a 12-lead from first medical contact?
Less than 10min where possible
Phosphodiesterase (PDE) 5 inhibitor list?
16
what are many known as?
- Viagra
- Levitra
- Cialis
- Revatio
- Sildenafil
- Tadalafil
- Vardenafil
- Udenafil
- Avanafil
- Lodenafil
- Mirodenafil
- Acetildenafil
- Aildenafil
- Benzamidenafil,
- Zaprinast
- Icariin (a natural product)
Erectile dsyfunciton drugs
Cardiac Ischemia Extra Questions
What other body systems could be considered when assessing for cardiac
ischemia?
Top 4 DDX?
HR
RR
Skin Condition
Abdominal(nausea)
Upper body pain (neck/jaw/shoulder)
GERD
Peptic ulcer disease
costochondritis
pleuritis
Cardiac Ischemia Extra Questions
Why does no prior use of ASA if the pt is asthmatic matter as a CONTRAINDICATION?
What’s the danger of active bleeding making it a CONTRAIDICATION for ASA
Why does a CVA/TBI in the previous 24h matter for giving ASA?
ASA is known to cause bronchospasm and therfore further the asthma exacerbation
If ASA is given during active bleeding - it inhibits platlet aggregation
^ the bleeding is prolonged
Cardiac Ischemia Extra Questions
What is a PDE-I/why does it matter if the pt has taken any within the previous 48h?
How do you check for 12-lead ECG right ventricular MI?
Phosphodiesterase inhibitor
smooth muscle relaxation
vasodilatory
bronchodilatory effects
The drug inhibits cAMP (cyclic AMP)
There is an inferior STEMI with ST elevation in lead III > lead II
V1 is isoelectric while V2 is significantly depressed
There is ST elevation throughout the right-sided leads V3R-V6R
Cardiac Ischemia Extra Questions
Why does ASA come before 12-lead interpretation?
Show me where you would place leads for a 15-lead interpretation?
What should you do if you don’t get a 12-lead on wihtin 10min of the first medical contact of the pt?
There is no CONTRAINDICATION (seen in an ECG) for ASA and there are minimal conditions to give the LIFE-SAVING medication.
Document it in your EACR
Cardiac Ischemia Extra Questions
Do you repeat the 12-lead if you identify a STEMI?
What if you don’t find any evidence of a STEMI?
Why can you apply the cardiac ischemia medical directive for ASA as if no care has been provided care prior to you arrival?
NO
A serial 12-lead is recommended
Because the paramedics dose does not exceed the theapeutic dose (80-1500mg is the effective dose without side effects)
Cardiac Ischemia Extra Questions
Explain what it means for nitroglycerin when the conditions say “a prior hx OR an established IV’?
Extra (in the companion doc) to say about ^^
Prior hx means authorized or prescribed to the pt by a certified medical doctor
An established IV gives you the ability to reverse the negative side effects
IV has to be initiated prior to administration in 1st time cardiac ischemia pts
If there were already an IV then it would need to be inspected
This only applys to PCP Autonomous IV people
Cardiac Ischemia Extra Questions
What does the reduced max number of doses for nitroglycerin in a pt with a STEMI mean?
Does nitroglycerin save the pt? Are there any precaustions?
Can you use CPAP in patients with suspected cardiac ischemia?
It reduces the adverse outcomes associated with liberal nitroglyercin use
No it’s a symptom relief
Yes as long as they meet the indications for the continous postive airway pressure medical directive too.