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5TH YR- Dental Medical Emergencies > Acute Cardiac Ischaemia > Flashcards

Acute Cardiac Ischaemia Flashcards

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USMLE® Step 1 flashcards
1
Q

Name the 2 subcategories of cardiac ischaemia

A
  1. Stable Angina
  2. Acute coronary syndrome
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2
Q

What should we do if we suspect a patient is suffering from a stable angina attack

A
  1. Allow pt to rest
  2. 2 activations of GTN
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3
Q

What should we do if we suspect a patient is suffering from acute coronary syndrome

A
  1. 2 Activations of GTN
  2. 300mg of aspirin
  3. Call 999
  4. Give oxygen if saturation falls under 94%
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4
Q

What should we do once we’ve delivered 1st line treatment to a patient suffering from acute cardiac ischaemia

A

Reassess the patient and respond as necessary

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5
Q

If after first line treatment a patients conditions appears to improve what should you do

A

Monitor and perform safe discharge

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6
Q

If after first line treatment a patients conditions appears to stay the same what should you do

A

Give 2 activations of GTN every 5 minutes for up to 6 doses in total

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7
Q

If after first line treatment a patients conditions appears to worsen what should you do

A

Give 2 activations of GTN every 5 minutes for up to 6 doses in total

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8
Q

What acronym do we use to identify cardiac ischaemia

A

THE DRS

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9
Q

What does THE DRS stand for

A

Trigger
History
Episodes

Duration
Resolution
Severity

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10
Q

Talk through THE DRS presentation of a patient suffering from stable angina

A

T- Obvious trigger eg emotional/exertion
H- Pt has known angina
E- No increased frequency of episodes

D- Symptoms resolve in less than 15 mins
R- Episodes resolves with rest of fast responses to GTN
S- pt describes pain as being typical of normal angina

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11
Q

Talk through THE DRS presentation of a patient suffering from acute coronary syndrome

A

T- Unclear trigger
H- Pt has had no previous history of chest pain
E- Increased frequency of episodes

D- Symptoms continue for more than 15 mins
R- slow or minimal response to GTN
S- pt describes pain as worse than typical angina pain

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12
Q

When should you call an ambulance

A
  1. Any patient with chest pain for the first time
  2. Any patient with features of acute coronary syndrome
  3. If patient is not improving or worsening after treatment
  4. Patient is being treated for hypoxaemia
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13
Q

How much dose a single activation of GTN equate to

A

400micrograms of glycerol Trinitrate

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14
Q

How many activations of GTN can be given under a single administration episode

A

2

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15
Q

How many minutes is needed between administration episodes

A

5 minutes

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16
Q

How many activations can we give to one patient at a given time

A

6 Activations

17
Q

What are the side effects of GTN

A
  1. Hypotension
  2. Headache
  3. Flushing
  4. Blurred vision
  5. Bradycardia
  6. Nausea
  7. Breathlessness
  8. Weakness
18
Q

In whom should GTN not be used

A

Patients:
1. Allergic to nitrate medicine
2. Who are hypotensive
3. With mitral stenosis s
4. Who are pregnant
5. Whit obstructive cardiomyopathy
6. With incipient glaucoma
7. On viagra

19
Q

Talk through how we administer GTN

A
  1. Hold the bottle upright DO NOT SHAKE
  2. Activate the pup in the air to ensure the pump is working
  3. Position the patient so that you can spray under their tongue AND place the upright bottle against the patients chin
  4. instruct he patient not to breath in when you activate the pup
  5. Insert t the patient to close their mouth
  6. Note don the time
20
Q

If we suspect acute coronary syndrome what can we Gove to the patient

A

Aspirin

21
Q

How much aspirin is equivalent to one dose

A

300 Milligrams

22
Q

How do we give aspirin

A

Either orally (dissolved, crushed or chewed)
or buccally

23
Q

Give the indication that oxygen should be used

A

If the oxygen saturation falls under 94%

24
Q

What can acute cardiac ischaemia be mistaken for

A
  1. Asthma
  2. Hyperventilation
  3. Anaphylaxis
25
Q

What unique characteristic would confirm acute cardiac ischaemia over asthma

A

Chest Pain

26
Q

What unique characteristics would confirm asthma over acute cardiac ischaemia

A

Wheeze
Prolonged expiratory phase

27
Q

What do acute cardiac ischaemia and asthma have in common

A
  1. Decreased oxygen saturation
    2High respirate rate
  2. High heart rate
  3. Arrhythmia (late sign in asthma)
  4. Central / peripheral cyanosis
  5. Confusion/ reduced consciousness
  6. Anxiety
  7. Hypotension (rare in ACI but life threatening in asthma)
28
Q

What unique characteristics would confirm acute cardiac ischaemia over hyperventilation

A
  1. Decreased oxygen saturation
  2. Central / peripheral cyanosis
  3. Confusion/ reduced consciousness
  4. Arrhythmia
  5. Hypotension (rare)
29
Q

What unique characteristics would confirm hyperventilation over acute cardiac ischaemia

A
  1. Normal oxygen saturations
  2. Lip/ mouth tingling
  3. Tinnitus
  4. Blotchy rash
    5.
30
Q

What do acute cardiac ischaemia and Hyperventilation have in common

A
  1. High respiratory rate
  2. High heart rate
  3. Chest pain
  4. Anxiety
  5. High level of respirate effort
  6. Dizziness
31
Q

What unique characteristics would confirm acute cardiac ischaemia over anaphylaxis

A
  1. Chest pain
  2. Patietn would appear pale and clammy
32
Q

What unique characteristics would confirm anaphylaxis over acute cardiac ischaemia

A
  1. Wheeze/ stridor
  2. Angioedema
  3. Urticarial / erythematous rash
  4. Hoarseness
  5. Lip/ mouth tingling
  6. Diarrhoea
  7. Vomiting
33
Q

What do acute cardiac ischaemia and Hyperventilation have in common

A
  1. Decreased oxygen saturation
  2. High heart rate
  3. High respiratory rate
  4. Anxiety
  5. Central/ peripheral cyanosis
  6. Confusion. reduced consciousness
  7. Hypotension
34
Q

what does aspirin do

A

It prevents platelets from sticking together

35
Q

What does the lack of platelets sticking together mean

A

Reduces blood cloth formation therefore increasing blood flow to the heart muscles

36
Q

When is aspirin contraindicated

A

If patient is allergic

37
Q

Which route is faster oral or buccal when delivering astham

A

Buccal route as it avoids the stomach

5TH YR- Dental Medical Emergencies (3 decks)

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