Chest pain

Question 1

Non-diagnostic ECGs with potential “imitators” of ACS or ECGs that are clinically
concerning should be described to the receiving hospital or OLMC.
These may include:

Answer 1

• LBBB or RBBB
• LVH
• SVT with aberrancy
• Paced rhythms
• Pericarditis
• Benign early repolarization
• Digitalis effect

Question 2

After stemi is recognized what are two indicators you can give hospital

Answer 2

stemi alert or stemi pt

Question 3

DO NOT ___ ADMINISTRATION OF ASPIRIN TO OBTAIN 12 LEAD

Answer 3

DELAY

Question 4

Contraindications to administration of aspirin:

Answer 4

1. Allergy to aspirin or aspirin induced asthma.
2. History of active bleeding disorder, (i.e., hemophilia).
3. Current ulcer or GI bleeding.
4. Suspected aortic dissection.

Question 5

If 12-Lead ECG is obtained, use ____ as assigned at birth. If patient does not
disclose, use default setting (male)

Answer 5

biological sex

Question 6

Do not administer nitroglycerin without OLMC if patient has taken Viagra or other
similar drugs in the last ___ hours or Cialis (tadalafil) within last ___hours

Answer 6

24, 48

Question 7

NTG administration to patients with an acute inferior wall myocardial infarction should
be performed with close monitoring of vital signs and rhythm. NTG in these patients
may result in ____

Answer 7

symptomatic hypotension and/or shock which should be treated with usual
measures (fluids, changes in position, medications if necessary).

Question 8

Maintain O2 sat above

Answer 8

95

Question 9

Start IV/IO prior to administration of nitroglycerin for patients who have ___
taken nitroglycerin;

Answer 9

never

Question 10

Drugs for AMI

Answer 10

1. Administer aspirin PO (approximately 324 mg) unless contraindicated.
2. After 12-lead is obtained, nitroglycerin 0.4 mg SL (spray, tablet or powder) every 5 min,
   if systolic BP is equal to or greater than 100 mm/Hg, or until chest pain is relieved.
3. For pain unrelieved after 3 nitroglycerin, and if the BP is greater than 100 mm/Hg
   systolic, administer fentanyl 25-100 micrograms IV/IO/IN; may repeat every
   3-5 minutes as needed to a MAX of 400 micrograms. Or, fentanyl 25-100 IM;
   may repeat every 15 minutes to a MAX of 400 micrograms. Nitroglycerin may
   be continued for strong suspicion of acute coronary syndrome.

Question 11

If nitro doesnt relieve pain after three doses do this

Answer 11

if the BP is greater than 100 mm/Hg systolic, administer fentanyl 25-100 micrograms IV/IO/IN; may repeat every 3-5 minutes as needed to a MAX of 400 micrograms. Or, fentanyl 25-100 IM; may repeat every 15 minutes to a MAX of 400 micrograms. Nitroglycerin may
be continued for strong suspicion of acute coronary syndrome.

Question 12

How often do you give nitro?

Answer 12

every 5 minutes