Acute Cardiac Ischaemia Flashcards
(37 cards)
Name the 2 subcategories of cardiac ischaemia
- Stable Angina
- Acute coronary syndrome
What should we do if we suspect a patient is suffering from a stable angina attack
- Allow pt to rest
- 2 activations of GTN
What should we do if we suspect a patient is suffering from acute coronary syndrome
- 2 Activations of GTN
- 300mg of aspirin
- Call 999
- Give oxygen if saturation falls under 94%
What should we do once we’ve delivered 1st line treatment to a patient suffering from acute cardiac ischaemia
Reassess the patient and respond as necessary
If after first line treatment a patients conditions appears to improve what should you do
Monitor and perform safe discharge
If after first line treatment a patients conditions appears to stay the same what should you do
Give 2 activations of GTN every 5 minutes for up to 6 doses in total
If after first line treatment a patients conditions appears to worsen what should you do
Give 2 activations of GTN every 5 minutes for up to 6 doses in total
What acronym do we use to identify cardiac ischaemia
THE DRS
What does THE DRS stand for
Trigger
History
Episodes
Duration
Resolution
Severity
Talk through THE DRS presentation of a patient suffering from stable angina
T- Obvious trigger eg emotional/exertion
H- Pt has known angina
E- No increased frequency of episodes
D- Symptoms resolve in less than 15 mins
R- Episodes resolves with rest of fast responses to GTN
S- pt describes pain as being typical of normal angina
Talk through THE DRS presentation of a patient suffering from acute coronary syndrome
T- Unclear trigger
H- Pt has had no previous history of chest pain
E- Increased frequency of episodes
D- Symptoms continue for more than 15 mins
R- slow or minimal response to GTN
S- pt describes pain as worse than typical angina pain
When should you call an ambulance
- Any patient with chest pain for the first time
- Any patient with features of acute coronary syndrome
- If patient is not improving or worsening after treatment
- Patient is being treated for hypoxaemia
How much dose a single activation of GTN equate to
400micrograms of glycerol Trinitrate
How many activations of GTN can be given under a single administration episode
2
How many minutes is needed between administration episodes
5 minutes
How many activations can we give to one patient at a given time
6 Activations
What are the side effects of GTN
- Hypotension
- Headache
- Flushing
- Blurred vision
- Bradycardia
- Nausea
- Breathlessness
- Weakness
In whom should GTN not be used
Patients:
1. Allergic to nitrate medicine
2. Who are hypotensive
3. With mitral stenosis s
4. Who are pregnant
5. Whit obstructive cardiomyopathy
6. With incipient glaucoma
7. On viagra
Talk through how we administer GTN
- Hold the bottle upright DO NOT SHAKE
- Activate the pup in the air to ensure the pump is working
- Position the patient so that you can spray under their tongue AND place the upright bottle against the patients chin
- instruct he patient not to breath in when you activate the pup
- Insert t the patient to close their mouth
- Note don the time
If we suspect acute coronary syndrome what can we Gove to the patient
Aspirin
How much aspirin is equivalent to one dose
300 Milligrams
How do we give aspirin
Either orally (dissolved, crushed or chewed)
or buccally
Give the indication that oxygen should be used
If the oxygen saturation falls under 94%
What can acute cardiac ischaemia be mistaken for
- Asthma
- Hyperventilation
- Anaphylaxis
