Cardiac

Question 1

1. What is the Rx for ACS?

Answer 1

• 12-lead within 10mins
• Request early MICA/HEMS for suspected STEMI and notify hospital
• Aspirin 300mg
• GTN 600mcg or 300mcg (no prev. admin, borderline BP or ≤60kg/elderly/frail - repeat @5min intervals titrated to pain/side effects
• GTN patch 50mg (0.4mg/hr)
• Inadequate response - treat with opioids

Question 2

2. What is the Rx for AF and SVT deteriorating to the point of cardiac arrest?

Answer 2

Synchronised cardioversion 200J

Question 3

3. What is the process of Modified Valsalva? Standard Valsalva?

Answer 3

1. Position semi-recumbent (45deg angle)
2. Forced expiration - 15secs into 10mL syringe
3. Immediately lay pt flat and raise legs to 45deg angle for 15secs
4. Return pt to semi-recumbent position
   (Patients must have SBP≥90)
   Standard: supine, forced expiration

Question 4

4. What is the Rx for Stable SVT (AVNRT or AVRT)?

Answer 4

• Exclude AF and atrial flutter

- SBP≥90 - 12 lead - Modified or standard valsalva, repeat x2 @ 2min intervals (max 3 attempts)

Question 5

5. What are the C/I to CPAP? GASHFAP

Answer 5

GCS<13
Active vomiting
need for Secure airway
Hypoventilation
Facial trauma
Arrhythmias (life threatening)
Pneumothorax

Question 6

6. What is the Rx for cardiogenic PO?

Answer 6

• Short of breath and crackles: GTN 600mcg or 300mcg if no prev. admin, borderline BP, ≤60kg/elderly/frail - repeat at 5min intervals
  + GTN patch
• No improvement or full field APO: CPAP, suction and assisted ventilation if required

Question 7

7. What is the Rx for a STEMI?

Answer 7

• Transmit ECG, request MICA, Rx as per ACS
• Time to PCI<1hr - Tx with hospital notification, Heparin IV bolus 4000IU (must consult) repeat 1000IU @1hr intervals, capture repeat ECG 30mins prior to arrival