Acute Myocardial Infarction

Question 1

What HPI questions do you want if AMI is suspected?

Answer 1

Age, medications, PMH of angina, HTN, DM, allergies, recent physical exertion, onset, quality, region and radiation, severity, time, ED drugs

Question 2

Which drugs do you want to ask about before administering Nitro?

Answer 2

ED drugs, Cialis, Viagra, Levitra

Question 3

What are some differentials of AMI?

Answer 3

pericarditis, pulmonary embolism, asthma/COPD, pneumothorax, aneurysm, GI reflux, esophageal spasm, pleural pain

Question 4

What is the EMT-B part of this protocol?

Answer 4

General impression, ABC, oxygen, aspirin, 12 lead, pt’s own nitro

Question 5

When should you suspect a right sided MI?

Answer 5

When there is elevation in II, III, aVF, or V1. Move V4 to V4 R

Question 6

What should you do with ST elevation and right sided involvement?

Answer 6

administer normal saline 250 ml bolus to keep systolic BP above 90 (max 20ml/kg). If hypotension persists then administer Levophed, consider administration of Fentanyl.

Question 7

What should you do with ST elevation without right sided involvement?

Answer 7

administer Nitroglycerin 0.4mg SL every 5 minutes if the pt. blood pressure is above 90 mmHg, and mo ED drugs.

Question 8

What should be done with suspected ischemia but no ST elevation?

Answer 8

With hold nitrates, consider Fentanyl.

Question 9

Which drug can you give for associated nausea and vomiting? What is the dose?

Answer 9

Ondansetron 0.1mg/kg slow IVP over 2-5 minutes. Max is 4.0 per dose.

Question 10

Which hospitals have an emergency cath lab?

Answer 10

VCU, St. Mary’s Chippenham, Henrico’s Forest, Memorial Regional, McGuire’s.

Question 11

What is the dosage of Fentanyl?

Answer 11

1 - 3 mcg/kg slow IVP

Question 12

What is the dosage of Zofran?

Answer 12

0.1mg/kg slow IVP over 2-5 minutes. Max per dose 4 mg