Acute Cardiac Ischaemia

Question 1

what are the symptoms?

Answer 1

chest pain
radiation
shortness of breath
nausea
abdo pain
fatigue

• decreased O2 saturation
• high resp rate
• high heart rate

Question 2

what are the two types of cardiac ischaemia
- how would you treat them?

Answer 2

angina
- consistent, predictable symptoms
tx: rest, 2 activations of GTN
- monitor and discharge if it gets better
- 999 if not

acute coronary syndrome
tx: call 999, 2 activations of GTN, 300mg aspirin, oxygen if <96%

Question 3

how would you know the difference between angina and acute coronary syndrome?

Answer 3

THE DRS
- trigger, history, episodes, duration, resolution and severity

Angina
- trigger - exertion/emotion
- history - known history of angina
- episodes - consistent freq.
- duration - <15 mins
- resolution - with rest or GTN
- severity - consistent symptoms

Acute Coronary Syndrome
- trigger - unclear
- history - no prev history
- episodes - increased freq.
- duration - >15mins
- resolution - minimal response to GTN
- severity - worse than usual angina

Question 4

GTN
- dosage
- side effects
- contraindications
- administering

Answer 4

dosage
- x2 activations = 800mcg
max 6 activations, with 5 mins between each episode

side effects
- hypotension and bradycardia
- headache
- blurred vision
- nausea

contraindications
- if systolic <90
- if central capillary refill time >2second
- allergies

administering
- DO NOT SHAKE
- hold upright
- activate
- spray under tongue, holding bottle against the chin
- not down the time

Question 5

aspirin for ACS
- dosage

Answer 5

single dose of 300mg

• can be oral or buccal

Question 6

prescribing oxygen
- dosage

Answer 6

if the O2 saturation <94%

dosage
- 5-10 L/min via simple face mask

• if risk of hypercapnia
• 1-2 L/min via nasal cannula

Question 7

how do you know its ACI and not asthma?

Answer 7

the differences:

ACI
- chest pain, nausea, pale

asthma
- prolonged expiratory phase

Question 8

how do you know its ACI and not hyperventilation?

Answer 8

the differences:

ACI
- decreased O2 saturation
- hypotension
- arrhythmia

hyperventilation
- normal O2 saturation
- lip/mouth tingle
- rash
- tinnitus
- muscle spasms

Question 9

how do you know its ACI and not anaphylaxis?

Answer 9

ACI
- chest pain
- pale and clammy

anaphylaxis
- stridor
- hoarseness
- diarrhoea
- lip/mouth tingle