ALS PCS: Cardiac Ischemia Medical Directive

Question 1

INDICATIONS

Answer 1

SUSPECTED CARDIAC ISCHEMIA

Question 2

ASA CONDITIONS (3)

Answer 2

≥18 YEARS

UNALTERED

ABLE TO CHEW AND SWALLOW

Question 3

NTG CONDITIONS (5)

Answer 3

≥18 YEARS

UNALTERED

60 ≤ HR < 160

SBP ≥ 100 (NORMOTENSION)

PRIOR HISTORY OF NTG USE OR IV ACCESS OBTAINED

Question 4

ASA CONTRAINDICATIONS (4)

Answer 4

ALLERGY OR SENSITIVITY TO ASA OR NSAIDs

IF ASTHMATIC, NO PRIOR USE OF ASA

CURRENT ACTIVE BLEEDING

CVA OR TBI (PAST 24 HOURS)

Question 5

NTG CONTRAINDICATIONS (4)

Answer 5

ALLERGY OR SENSITIVITY TO NITRATES

PHOSPHODIESTERASE INHIBITOR USE WITHIN PREVIOUS 48 HOURS.

SBP DROPS BY 1/3 OR MORE OF ITS INITIAL VALUE AFTER NTG IS ADMINISTERED

12-LEAD ECG COMPATIBLE WITH RVI

Question 6

PDE5 INHIBITOR LIST

Answer 6

MAINLY: LEVITRA, CIALIS, VIAGRA

SILDENAFIL
TADALAFIL
VARDENAFIL
UDENAFIL
AVANAFIL
LODENAFIL
MIRCODENAFIL
ACETIDENAFIL
AILDENAFIL
ZAPRINAST

Question 7

TREATMENT WITH ASA

Answer 7

ROUTE: PO

DOSE: 160mg - 162mg

MAX SINGLE DOSE: 162mg

DOSING INTERVAL: N/A

MAX # OF DOSES: 1

Question 8

TREATMENT WITH NTG

NSTEMI

Answer 8

SBP ≥ 100mmHg

ROUTE: SL

DOSE: 0.3mg OR 0.4mg

MAX SINGLE DOSE: 0.4mg

DOSING INTERVAL: 5mins

MAX # OF DOSES: 6

Question 9

TREATMENT WITH NTG

STEMI-POSITIVE

Answer 9

SBP ≥ 100mmHg

ROUTE: SL

DOSE: 0.3mg OR 0.4mg

MAX SINGLE DOSE: 0.4mg

DOSING INTERVAL: 5mins

MAX # OF DOSES: 3

Question 10

CLINICAL CONSIDERATIONS

Answer 10

SUSPECT RVI IN ALL INFERIOR STEMIs AND PERFORM 15-LEAD ECG TO CONFIRM (ST ELEVATION ≥1mm IN V4R)

DO NOT ADMINISTER NTG TO A PATIENT WITH RVI

IV CONDITIONS APPLIES ONLY TO PCPs AUTHORIZED FOR PCP AUTONOMOUS IV.

Question 11

RVI PRESENTATION

Answer 11

SLOW PULSE

HYPOTENSION

JVD

CLEAR LUNGS