ACS part 2 Flashcards
if initial ECG is not diagnostic what do you do
serial ECG every 15-30 minutes for the first hour
serial troponin levels:
-levels should be obtained at presentation and 3-6 hours after symptom onset
- high sensitivity preferred
- repeating troponin levels will identify a rising and/or falling pattern
MONA
morphine
oxygen
nitroglycerin
aspirin
morphine info from slides
- relieve chest pain
- initial dose: 4-8 mg IV, followed by 2-8 mg IV q5-15 minutes
morphine side effects: 3
sedation, respiratory depression, N/V
T or F: Avoid NSAIDs during hospitalization
True, especially aspirin
why do you avoid NSAIDs during hospitalization
NSAIDs lead to sodium and water retention which leads to an increased risk of MACE
oxygen early hospital care
maintain saturation >90%
early hospital care: NTG
-vasodilator that increases blood flow to the heart
- sublingual NTG: 0.3-0.4 mg q5min x 3 for ischemic pain
- IV NTG: for persistent ischemia, HF, or HTN
doses for IV NTG
start at 10 mcg/min, titrate by 5mcg/min q5min (max is 200 mcg/min)
side effects NTG
headache, hypotension
tachyphylaxis=
when a drug loses part of or its entire efficacy over time as the body develops tolerance to it
nitrates are CI’s with recent use of PDE-5 inhibitors, give the times considered “recent” for the following:
sildenafil
vardenafil
tadalafil
24 hours
24 hours
48 hours
early hospital care: aspirin
- 162-325 mg chewable aspirin x 1 dose
- given to ALL patients without contraindications ASAP
what are two procedures for reperfusion
PCI and CABG
what is a pharmacological option for reperfusion
fibrinolytic therapy
“absolute” contraindications to fibrinolytics: (6)
- history of intracranial hemorrhage
- ischemic stroke within 3 months
- presence of a cerebral vascular malformation or a primary or metastatic intracranial malignancy
- aortic dissection
- active bleeding
- significant closed-head or facial trauma within last 3 months
T or F: Reperfusion therapy doesn’t need to be administered in all STEMI patients whose symptoms began in the past 12 hours
F, it should be
reperfusion therapy: STEMI
door-to-needle time:
door-to-balloon time:
within 30 minutes of hospital arrival
within 90 minutes of hospital arrival
