ACS pt 2

Question 1

when should pt have an ECG?

Answer 1

within 10 mins of arrival

Question 2

if initial ECG doesn’t show anything when should it be repeated?

Answer 2

every 15-30 mins for first hour

Question 3

when should troponin be measured?

Answer 3

at arrival and 3-6 hours after

Question 4

morphine initial dose

Answer 4

4-8 mg IV then 2-8 mg IV q5-15 mins

Question 5

side effects morphine

Answer 5

sedation, respiratory depression, N/V

Question 6

oxygen should be kept to what sat

Answer 6

90%

Question 7

nitroglycerin tablet dose given

Answer 7

0.3-0.4 mg q5min x 3

Question 8

IV nitroglycerin dose

Answer 8

10 mcg/min titrate by 5 mcg/min q 5min to max of 200

Question 9

nitroglycerin side effects

Answer 9

headache, hypotension

Question 10

why are nitrates contraindicated w PDE inhibitors?

Answer 10

cause vasodilation and hypotension

Question 11

fibrinolytics convert what

Answer 11

plasminogen to plasmin which helps fibrin degrade

Question 12

fibrinolytic drugs

Answer 12

tenecteplase, reteplase, alteplase

Question 13

STEMI pts: PCI or fibrinolytic?

Answer 13

PCI for all pts with symptoms starting within 12 hours

Question 14

door to needle time for STEMI?

Answer 14

30 mins

Question 15

door to balloon time for STEMI?

Answer 15

90 mins

Question 16

when to use fibrinolytics?

Answer 16

non PCI capable hospital within 120 mins

Question 17

NSTEMI pts: early invasive or ischemia guided?

Answer 17

early invasive: high risk pts like ST depression, rising troponin, refractory angina
ischemia guided: medical management

Question 18

symptoms of ACS

Answer 18

N/V, diaphoresis, SOB

Question 19

atypical ACS symptoms

Answer 19

epigastric pain, indigestion, stabbing pain, dyspnea w/o chest pain

Question 20

STEMI ECG findings

Answer 20

ST elevation
Q wave changes

Question 21

NSTEMI ECG findings

Answer 21

ST depression, T wave inversion

Question 22

high sensitivity troponin normal level

Answer 22

<14 ng/L

Question 23

conventional troponin normal level

Answer 23

<0.05 ng/mL

Question 24

sensitivity

Answer 24

likelihood of detecting disease that exists

Question 25

specificity

Answer 25

likelihood of not detecting a disease when it dose not exist