acute coronary syndromes Flashcards
1
Q
items of immediate assessment (<10 min)
A
- check vital signs with automatic or standard BP cuff
- determine oxygen saturation
- obtain IV access
- obtain 12-lead ECG
- obtain a brief targeted history and perform a physical exam
- use checklist (yes-no)
- focus on eligibility for fibrinolytic therapy
- obtain blood sample for initial cardiac marker levels
- initiate electrolyte and coagulation studies
2
Q
immediate general treatment
A
- oxygen- maintain oxygen saturation 94-99%
- aspirin 160 to 325 mg
- nitroglycerin SL or spray- pain relief
- morphine IV (if pain not relieved with nitroglycerin)- pain and anxiety relief
- MOAN
3
Q
oxygen used in acute coronary syndromes
A
- why- increases supply of oxygen to ischemic tissue
- lack of circulation and oxygen
- when- always when AMI is suspected
- how- start with nasal cannula at 4 L/min
- maintain oxygen saturation 94-99%
- remember one word- oxygen-IV-monitor
- WATCH OUT!- rarely COPD patients with hypoxic ventilatory drive will hypoventilate
4
Q
nitroglycerin: actions
A
- increases venous dilation
- decreases venous blood return to heart -> heart works less hard
- decreases preload and cardiac oxygen consumption
- dilates coronary arteries
- increases cardiac collateral flow
- the result: decreases pain of ischemia*
5
Q
nitroglycerin: non-indication
A
- response to nitro is not a clinical test- reaction doesnt mean anything
- pain may diminish despite non-cardiac etiology
- pain may persist despite definite cardiac etiology
6
Q
nitroglycerin: dose
A
- sublingual (under the tongue) -> into circulation quickly
- .4mg; repeat every 5 minutes
7
Q
nitroglycerin precautions
A
- use extreme caution if systolic BP <90 mm Hg
- use extreme caution in right ventricular infarction -> you may lose more preload
- suspect RV infarction with inferior ST changes
- limit BP drop to 10% if patient is normotensive
- limit BP drop to 30% if patient is hypertensive
- watch for headache, drop in BP, syncope, tachycardia -> (from the drop in preload)
- tell patient to sit or lie down during administration
8
Q
morphine sulfate: actions, indications
A
- or pentanol
- why (actions):
- to reduce pain of ischemia
- to reduce anxiety
- to reduce extension of ischemia by reducing oxygen demands
- when (indications):
- continuing pain
- evidence of vascular congestion (acute pulmonary edema)
- systolic blood pressure >90 mmHg
- no hypovolemia
9
Q
morphine sulfate: dose, precautions
A
- how (dose):
- 2-4 mg titrated to effect
- goal- eliminate pain
- watch out for (precautions):
- drop in BP, especially in pts with volume depletion, increased systemic resistance, RV infarction*
- depression of ventilation
- nausea and vomiting (common)
- bradycardia
- itching and bronchospasm (uncommon)
10
Q
aspirin: actions
A
- why (actions):
- blocks formation of thromboxane A2 (thromboxane A2 causes platelets to aggregate and arteries to constrict)
- prevents more clots from happening
- does nothing for clots that are already there
- these actions will reduce:
- overall mortality from AMI
- nonfatal reinfarction
- nonfatal stroke
11
Q
aspirin: indications, dose, precautions
A
- when (indications) as soon as possible:
- standard therapy for all patients with new pain suggestive of AMI
- give within minutes of arrival
- how? (dose): 160-325 mg tablet taken as soon as possible
- watch out (precautions):
- relatively contraindicated in patients with active peptic ulcer disease or asthma
- contraindicated in patients with known aspirin hypersensitivity
- bleeding disorders
- severe hepatic disease
12
Q
assess initial 12-lead ECG findings: ST elevation AMI
A
- ST elevation or new or presumably new left bundle branch block: strongly suspicious for injury
- stemi
- more likely to have a complete blockage
- primary intervention PTCA -> catheter and opening vessel directly
13
Q
assess initial 12-lead ECG findings: high risk unstable angina/non-ST elevation AMI
A
-ST depression or dynamic T wave inversion: strongly suspicious for ischemia
14
Q
assess initial 12-lead ECG findings: intermediate/low risk unstable angina
A
-nondiagnostic ECG: absence of changes in ST segment or T waves
15
Q
beta-blockers
A
- blocks catecholamines from binding to beta-adrenergic receptors
- slow heart rate
- reduces HR, BP, myocardial contractility
- decreases AV nodal conduction
- decreases incidence of primary VF
- adjunctive medication
