5 ACS part II Flashcards
initial recommendations
12 lead ECG
- within __ mins of arrival at an emergency facility
- if the initial ECG is not diagnostic but the patient remains symptomatic and there is a high clinical suspicion for ___ , serial ECGs should be performed every ___ - ___ min for the first hour
- 10
- ACS, 15-30
initial recommendations
serial troponin
- levels should be obtained at presentation and ___ - ___ hours after symptom onset
- ___ troponin is preferred
- repeating troponin levels will identify a rising and/or falling pattern
3-6
high sensitivity
UA/NSTEMI Treatment
MONA
Reperfusion
- early invasive strategy vs. ischemia guided strategy
- no ___
Antiplatelets
- DAPT = ___ and ___
- ___ month duration
- ___ or ___ preferred
- +/- GPIIb/IIIa inh (unlikely to use)
Anticoagulation
- LMWH or UFH
BB
ACEi or ARB
Statin
NTG prn
- fibrinolytic
- ASA, P2Y12
- 12
- ticagrelor, prasugrel
STEMI Treatment
MONA
Reperfusion
- ___ vs fibrinolytic
Antiplatelets
- DAPT = ___ + ___
- ___ month duration
- fibrinolytic: ___ preferred
- PCI: ___ or ___ preferred
- +/- GPIIb/IIIa inhibitior
Anticoagulation
- UFH or ___
BB
ACEi or ARB
Statin
NTG prn
- PCI
- ASA, P2Y12i
- 12
- clopidogrel
- ticagrelor, prasugrel
- bivalirudin
MONA
morphine
oxygen
NTG
ASA
early hospital care immediately upon arrival - MONA
morphine - to relieve chest pain
initial dose
- ___ - ___ mg IV
- followed by __ - __ mg IV q 5-15 min
SE
- seddation
- respiraotry depression
- N/V
Avoid NSAIDs during hospitalization (except ___ )
- NSAIDS lead to Na and water ___ = increase risk of ___
- 4-8, 2-8
- ASA
- retention, MACE
early hospital care - immediately upon arrival - MONA
oxygen
maintain O2 sat of > ___ %
90%
(dont need to initiate if above 90%)
pateints have trouble breathing due to impending feeling of doom
early hospital care - immediately upon arrival
Nitroglycerin (NTG)
- ___ = increase blood flow to the heart
SL NTG: ___ - ___ mg q __ min x 3 for angina
IV NTG: for persistent ischemia, HF, or HTN
- start at ___ mcg/min
- titrate by ___ mcg/min q 5 min (MAX: ___ mcg/min)
SE
- headache
- hypotension
vasodilator
0.3-0.4, 5
10
5
200
T or F: transdermal NTG is preferredd in the setting of ACS
FALSE
- has to absorb, not rapid, 15-60 min onset
NTG CI
nitrates are contraindicated with the use of a ___
sildenafil: within ___ hrs
vardenadil: within ___ hrs
tadalafil: within ___ hrs
PDEi
24
24
48
early hospital care - immediately upon arrival
ASA
___ - ___ mg chewable for 1 dose
- give to ALL patients without contraindications to ASA
162-325
if EC is all that is availabe, have pt chew
T or F: if the patient takes 81 mg ASA and they already too their dose that morning, we would still give a loading dose of 325 mg
T
the pt still needs a loading dose, If they just to their dose, you could give 3 additional 81 mg tabs (for a total dose of 324 mg)
Steps with Time
within 10 min of arrival: ___
- repeat q 15-30 min for 1 hour if patient remains symptomatic
at presentation: ___
- repeat q 3-6 hours for first 12 hours
immediately upon arrival: ___
ECG
high sensitivty troponin
MONA
reperfusion strategies
procedures: ___ and ___
PCOL: ___ therapy
PCI, CABG
fibrinolytic
Coronary Angiography - “heart cath”
shows which arteries in the heart have blockages
1) catheter is inserted into ___ and ___ artery and fed up to the heart
2) ___ is injected into coronary arteries
3) an ___ picture is taken and shows the blocked arteries
4) a ___ is place if needed
radial, femoral
dye
X-ray
stent
