ACS pt 2 Flashcards
when should pt have an ECG?
within 10 mins of arrival
if initial ECG doesn’t show anything when should it be repeated?
every 15-30 mins for first hour
when should troponin be measured?
at arrival and 3-6 hours after
morphine initial dose
4-8 mg IV then 2-8 mg IV q5-15 mins
side effects morphine
sedation, respiratory depression, N/V
oxygen should be kept to what sat
90%
nitroglycerin tablet dose given
0.3-0.4 mg q5min x 3
IV nitroglycerin dose
10 mcg/min titrate by 5 mcg/min q 5min to max of 200
nitroglycerin side effects
headache, hypotension
why are nitrates contraindicated w PDE inhibitors?
cause vasodilation and hypotension
fibrinolytics convert what
plasminogen to plasmin which helps fibrin degrade
fibrinolytic drugs
tenecteplase, reteplase, alteplase
STEMI pts: PCI or fibrinolytic?
PCI for all pts with symptoms starting within 12 hours
door to needle time for STEMI?
30 mins
door to balloon time for STEMI?
90 mins
when to use fibrinolytics?
non PCI capable hospital within 120 mins
NSTEMI pts: early invasive or ischemia guided?
early invasive: high risk pts like ST depression, rising troponin, refractory angina
ischemia guided: medical management
symptoms of ACS
N/V, diaphoresis, SOB
atypical ACS symptoms
epigastric pain, indigestion, stabbing pain, dyspnea w/o chest pain
STEMI ECG findings
ST elevation
Q wave changes
NSTEMI ECG findings
ST depression, T wave inversion
high sensitivity troponin normal level
<14 ng/L
conventional troponin normal level
<0.05 ng/mL
sensitivity
likelihood of detecting disease that exists
specificity
likelihood of not detecting a disease when it dose not exist
