AV - Adult - Cardiac - A0401 (ACS)

Question 1

A0401 (ACS)

Precis dot points?

Answer 1

Stop (2)
Ax (1)
Antiplatelet (1)
Nitrates, if pain (4)
Pain relief (1)
> MICA (2)
Gen. mx (5)

Question 2

A0401

Precis: Stop & Ax?

Answer 2

STOP:

• ACS may present with atypical / no pain
• STEMI&raquo_space; request early MICA / AAV

AX:
- 12-lead ECG < 10/60, if STEMI rx as per&raquo_space; A0408

Question 3

A0401

Precis: Antiplatelet & Nitrates?

Answer 3

ANTIPLATELET:
- Aspirin 300mg PO (if not already given)

NITRATES, IF PAIN:
- GTN 600mcg (SBP > 110)
or
- GTN 300mcg if no prev. admin, S/F/E (SBP > 100)
- Rpt 300mcg or 600mcg @ 5/60 TTR
- GTN 50mg td patch, 400mcg/hr release (SBP > 90)

Question 4

A0401

Precis: Pain relief & MICA?

Answer 4

PAIN RELIEF:
- pain relief other than nitrates, mx as per&raquo_space; A0501

MICA (HTN SBP > 160, DBP > 100)

• GTN
• Repeats

Question 5

A0401

Precis: General Mx

Answer 5

GEN. MX:
- Mx STEMI >> A0408
- Mx N + V >> A0701
- Mx LVF >> A0406 (APO)
- Mx Inadeq. perf. >> A0407
- Mx Arrhythmia:  
>> A0201 (medical SCA), 
>> A0402 (bradycardia), 
>> A0403 (NCT), 
>> A0404 (BCT)

Question 6

A0401

ACS - What are these conditions?

Answer 6

Acute coronary syndrome encompasses:

STEMI,
NSTEMI, and
Unstable angina

Question 7

A0401
True or false?
ALL patients w/ ACS present with pain

Answer 7

FALSE.

Pts who are elderly, female, phx diabetes, other atypical presentations

Question 8

A0401

How is an AMI diagnosed?

Answer 8

AMI diagnosed by:

Presenting hx,
Serial ECGs,
Serial enzyme test
myoglobin, troponin I, Creatine Kinase

Question 9

A0401
T / F ?
ACS requires routine O2 administration

Answer 9

FALSE.

Hyperoxaemia is detrimental to pts w/ STEMI.
Give O2 as per&raquo_space; A0001 (O2 rx)

Question 10

A0401
T / F ?
If a lower dose of aspirin (e.g. 100mg) has been given prior to AV arrival, paramedics cannot administer any more aspirin

Answer 10

FALSE.

Paramedics can supplement the dose to as close to 300mg as possible

Question 11

A0401

What is the intent of analgesia in ACS?

Answer 11

To make the pt as comfortable as possible.

Pain-free isn’t always possible and may even be detrimental if +++ opioids doses are given to try to achieve it

Question 12

A0401

Action for STEMI with onset < 12 hr?

Answer 12

Continue rx as per&raquo_space; A0408

Question 13

A0401

Action for STEMI with onset > 12 hr?

Answer 13

Transmit 12-lead ECG and give hospital notification

Question 14

A0401

Action for NSTEACS / unstable angina?

Answer 14

Tx to appropriate facility