11/25

Question 1

If the anticipated time from the first medical contact to PCI is >90-120 min, give __________ for STEMI if there is no contraindication

Answer 1

thrombolytics

Question 2

Standard ACS meds

Answer 2

Aspirin - 162-325 mg orally
Heparin: 5,000 units (≥50 kg)

Consider
-P2Y12 inhibitor: Clopidogrel 600 mg or ticagrelor 180 mg PO
- IV nitroglycerin
- beta blockade: anterior STEM within 6 hours and will go for primary PCI (not thrombolytic therapy) and no contraindications
Consider metoprolol 5mg IV

Question 3

STEMI thrombolytic contraindications

Answer 3

• Any prior ICH
• structural cerebral vascular lesion
• malignant intracranial neoplasm (primary or metastatic)
• Ischemic stroke within 3 mo
• aortic dissection
• Active bleeding
• Significant closed-head or facial trauma within 3 mo
• Intracranial or intraspinal surgery within 2 mo
• Severe uncontrolled hypertension dewspite therapy

For streptokinase, prior treatment within the previous 6 mo

Question 4

Tenecteplase (TNK-tPA) dose

Answer 4

70-79 kg: 40 mg
80-89 kg: 45 mg
>90 kg: 50 mg

Question 5

STEMI tPA dose
>67 kg

Answer 5

Alteplase (tPA): 100 mg over 1.5 h

• 15 mg IV over 1-2 min –>
• 50 mg over 30 min –>
• 35 mg over the next 60 min

Question 6

If you put the patient on the monitor you must say this:

Answer 6

GIVE ME A RYTHEM STRIP

Question 7

Do not give this cardiac med to patients receiving alteplase

Answer 7

nitroglycerin

increases the metabolism of alteplase and decreases the levels of alteplase and thus its efficacy

Question 8

Sublingual nitroglycerin dose

Answer 8

0.4 mg q5min
up to 3 doses as the blood pressure allows

*If given ask for BP

Question 9

Look at a v fib strip

Answer 9

go look
its just a bunch of pointy wide nothing

Question 10

SAY this dose for defibrillation

Answer 10

200 J

then

300 J

then

360 J