Cardiac

Question 1

Acute Coronary Syndrome CPG

Answer 1

May present atypical, no pain.
Early MICA for STEMI - pads, notify and transmit

12 lead ECG within 10/60

Aspirin 300mg orally (if not already administered)

GTN 600mcg/ SL if SBP >100
OR 300mcg if nil previous administration, frail, elderly, borderline BP

Repeat 5/60

GTN patch 50mg (0.4mg/hr) to patients L)upper chest *right side chest for pads if needed.
- remove if SBP <100

If C/I to nitrates
Treat as per Pain Relief- opioids

Question 2

Tachycardia (narrow complex)

Answer 2

Confirm narrow complex
QRS <0.12 sec
Absent or abnormal P waves
Exclude AF, atrial flutter unless rapidly deteriorating.
* Sinus tach not to be treated as per this CPG

SVT stable with BP >90
- modified Valsalva
Patient semi recumbent, forced expiration, lay patient flat and raise legs for 15 seconds

OR

Abdominal Valsalva
Patient supine, blowing into 10ml syringe for 15 seconds

• repeat x2 (max 3 attempts)

If BP <90 or no reversion with Valsalva, treat as per SVT BP <90 - MICA for Adenosine

Question 3

Bradycardia CPG

Answer 3

Symptomatic with any of the following:
- Less than adequate perfusion including STEMI/ischaemic pain
- APO with HR <40
-VT runs/vent escape rhythms
- HR <20

–> MICA
Unstable pt MICA treatment:
Atropine
inadequate response- Adrenaline infusion
Extremely poor perfusion persists
transthoracic pacing with Midaz/Fent

Question 4

Tachycardia (Broad complex)
What is the criteria for VT?

Answer 4

Fast: Rate >100
Wide: QRS >0.12 seconds
Regular
Sustained VT over 30 seconds requires management

Question 5

APO CPG management

What are some causes of cardiogenic and non cardiogenic acute pulmonary oedema? And how does treatment differ between the two causes.

Answer 5

Cardiogenic: Secondary to LVF or CCF. - treatment nitrates however asymptomatic APO doesnt require treatment.
Non cardiogenic causes: smoke/gas inhalation, anaphylaxis, near drowning (aspiration). ** doesnt require nitrates, however treat with o2 and assisted ventilation if required.

Treatment of symptomatic Cardiogenic APO
GTN 600mcg SL (if BP >100) 5/60
OR 300mcg SL 5/60 if borderline BP, frail, small or nil previous administration.

GTN patch

Nil improvement or full field APO
CPAP 10cm
Suction and assisted ventilation is req.

Question 6

CPAP indications for ALS and C/I

Answer 6

Indicated:
Full field APO/or nil improvement with nitrates

Contraindications
‘’’
Airway
-Inability to manage own airway ie. altered conscious state, active vomiting (aspiration risk), excessive secretions
‘’’
Breathing
- hypoventilation
- untreated suspected tension pneumothorax
‘’’
Circulation
- haemodynamic instability ie severe hypotension, ventricular arrhythmia
‘’’
Other
injuries preventing mask application

Indications for removal of CPAP
- Cardiac/resp Arrest
- mask intolerance
-decreasing respiratory effort
- nil improvement after 1 hour treatment
- deteriorating vital signs
- risk to patient (loss of airway control, copious secretions, active vomiting, paramedic judgment of clinical deterioration).