ACLS - Acute coronary syndrome Flashcards
Plaques, also called Atheromas, characteristically occur in regions of
____
branching and/or marked curvature (velocity and direction change)
_____ is the main event that
causes acute presentation of coronary syndromes.
Plaque rupture
Patients with coronary atherosclerosis may develop a spectrum of clinical
presentations, representing various degrees of coronary occlusion. This is called ____
Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome includes the following:
○ ST Elevation ACS (STEMI)
○ Non-ST Elevation ACS (NSTE-ACS)
■ Non-ST Elevation MI (NSTEMI)
■ Unstable Angina
T/F Half of the patients who die of ACS do so before reaching the hospital.
T
Key components and goals of the ACS Algorithm:
○ Rapid identification, assessment, and triage of acute chest pain
○ Initial treatment of possible ACS
○ Emphasis on early reperfusion of the patient with ACS/STEMI
Signs and Symptoms of ACS
● The most common symptom of myocardial
ischemia and infarction is retrosternal chest
discomfort (usually lasts more than for just a few minutes)
Clinical presentation that is also suggestive of ACS:
○ Chest discomfort that is spreading to the shoulders, neck, jaw, or the arms (can
be one or both).
○ Chest discomfort spreading into the back or between the scapula.
○ Chest discomfort with lightheadedness, dizziness, fainting, sweating, nausea, or
vomiting.
○ Unexplained, sudden shortness of breath, which may occur with or without
chest discomfort.
○ Less commonly, some may have epigastric discomfort described as indigestion.
● Diaphoresis with some dyspnea is common.
● An unusual fatigue
It’s also very important to realize that other potentially fatal conditions can
present in the same way (mimicking ACS)
○ Aortic dissection
○ Acute pulmonary embolism (PE)
○ Acute pericardial effusion with Tamponade
○ Tension pneumothorax
EMS Assessment and Care for ACS
○ Monitor and support airway, breathing, and circulation (ABCs).
○ Administer Aspirin and consider oxygen (if O2 saturation is under 90%), nitroglycerin, and morphine (if chest pain is unresponsive to nitro).
○ Obtain a 12-lead EKG and interpret or transmit for interpretation.
■ If there is ST elevation, EMS notifies receiving hospital
○ Especially if ST elevation is present, EMS should complete a prehospital fibrinolytic checklist (more to come) and hospital prepares
Aspirin dosing during EMS assessment and care for ACS
○ A dose of 162-325 mg of non-enteric-coated Aspirin causes near-total and immediate inhibition of platelet thromboxane production
○ This rapidly reduces platelet activation, stopping active thrombus formation and helps prevent coronary reocclusion.
○ Best absorbed if chewed rather than swallowed.
T/F Other than Aspirin, NSAIDs are contraindicated in ACS
T
Oxygen dosing for EMS care with ACS
○ Start oxygen at 4 L/min and titrate oxygen amount to maintain O2 saturation to at least 90%.
Nitroglycerin usage with EMS Assessment and Care for ACS
○ Is known to reduce ischemic chest discomfort and has some beneficial
hemodynamic effects (reduce preload due to vasodilation).
○ Avoid use if hypotensive, bradycardic, or tachycardic
○ Avoid use if recent Phosphodiesterase Inhibitor use
○ Avoid use if Inferior Wall MI and RV infarction
Morphine usage with EMS Assessment and Care for ACS
○ Morphine can be given for chest discomfort that is not responsive to Nitro
■ It produces CNS analgesia, which in turn reduces catecholamine release and
reduces heightened myocardial oxygen demand.
■ It produces vasodilation, decreasing LV preload
■ It decreases peripheral vascular resistance, decreasing LV afterload.
■ Helps redistribute blood in those with pulmonary edema, easing dyspnea