Cardiac Flashcards
Within what timeframe should a patient with acute chest pain / suspected ACS receive a 12 lead ECG?
How often should ECGs be repeated?
Within 10min of first clinical contact
Serial 12lead ECGs should be obtained every 10-15min until the patient is pain free
In which ACS conditions should GTN be used with caution?
GTN and other vasodilators must be used with caution or avoided in settings in which hypotension is likely or could result in serious haemodynamic decompensation, such as right ventricular infarction or severe aortic stenosis
In which ACS patients are opioids indicated?
Patients with an unacceptable level of pain that is unresolved with aspirin and GTN (single dose)
How does ECG acquisition change in patients with inferior STEMI?
Lead V4R should be obtained to investigate concomitant RV STEMI
Fill in the blank:
If symptoms persist after _____ doses of SL GTN, assessment for the need for alternative therapy should be made
3 doses of GTN
What treatment do patients with cardiogenic shock require?
Patients with cardiogenic shock will require clinical support for potential treatments which may include inotropes; and should be transported to a facility capable of providing emergency PCI without delay
What are the contraindications for GTN (3x)?
GTN contraindicated:
* if recent use of PDE-5 inhibitor drug (commonly for erectile dysfunction or pulmonary arterial hypertension): 24 hrs: sildenafil, vardenafil or avanafil; or 48 hrs: tadalafil
* in hypovolaemic states that cannot be corrected
* if SBP < 100 mmHg
What are the side effects of GTN (6x)?
Notable adverse effects include:
* severe headache
* flushing
* palpitations
* orthostatic hypotension (falls risks)
* fainting
* peripheral oedema
What is the onset time for GTN?
What is the duration of action?
Onset: almost immediate
Duration: 10-15min
What are the contraindications for aspirin (3x)?
- Anaphylaxis/severe allergy to aspirin and NSAIDs
- Severe active bleeding
- Pediatrics (associated with Reyes Syndrome)
What is the onset of action time for aspirin?
What are the adverse effects?
Onset: approx 10min
Adverse effects - GI irritation and increased bleeding time
What dose of aspirin should be given if patient has already taken aspirin today?
Normal dose: safe if patient has already taken aspirin, another antiplatelet and/or an anticoagulant earlier that day
When is fentanyl indicated in ACS?
Indicated when patient has
* severe unresolved pain despite treatment with aspirin and GTN
* GCS 15 or normal GCS
* SBP>= 100mm Hg
What are the indications for morphine in ACS (4x)?
Indicated when patient has all of
* severe unresolved pain despite treatment with aspirin and GTN
* GCS 15 or normal GCS
* SBP>= 100mmHG
* fentanyl unavailable or unsuitable
What dose of fentanyl may be given in ACS?
Repeat dose/interval?
Max dose
25-50mcg IV (slow push over 1min)
Repeat prn every 5min
Max dose 300mcg
What dose of morphine may be given in ACS?
Repeat dose/interval?
Max dose
2.5-5mg IV
Repeat prn every 5min
Max dose 30mg
How should ACS treatment be changed if opiates are given?
EtCO2 should be monitored if opiates administered
What are the indicators/criteria for cardiogenic shock (3x)?
Patient has:
* presumed cardiac chest pain and
* ischaemic ECG changes and
* SBP < 90 mmHg
What treatments should be performed if cardiogenic shock suspected (4x)?
- Request urgent clinical support
- IV access
- Consider posture & prepare for patient deterioration (i.e. pads)
- Rapid transport with notification
Which hospital should patients in cardiogenic shock be transported to?
Rapid transport with notification to:
Closest appropriate hospital if:
* without clinical support or
* in regional setting where PCI facility not available or
* patient unstable
PCI capable facility if:
* clinical support present and
* < 60 mins travel time
* Code STEMI notification if applicable
What ECG changes indicate a high-risk ACS patient?
ECG features in 2 or more contiguous leads
* ST depression > 0.5 mm or
* transient ST elevation > 0.5 mm
What risk factors for ischemic heart disease (i.e. previous medical conditions) indicate a high-risk ACS patient?
Risk factors for ischemic heart disease including
* Diabetes mellitus
* Chronic renal failure
* Previous PCI, AMI, coronary Stent or CABG
Where should high-risk/ACS patients be transported?
Transport ‘high-risk chest pain / ACS’ to:
PCI capable facility if < 60 mins travel time
Closest appropriate hospital if:
in regional setting where PCI facility not available or
patient unstable
In which patients should the STEMI tool be used?
Patients with all of
* Unresolved chest pain / ACS
* Onset < 12hrs
* Nil trauma
What ECG criteria denotes STEMI according to the STEMI tool?
Persistent ST elevation in >=2 contiguous leads in serial ECGs
According to the STEMI tool, what constitutes ST elevation?
For normal QRS duration (0.12s) or RBBB
* >=1mm in all leads other than V2-V3
In V2-V3
* >=2mm for men > 40yrs
* >=2.5mm for men < 40yrs
* >1.5mm for all women
How is Code STEMI activated?
What if the phone is unanswered?
Phone SA Code Notification line
Select “Code STEMI” and “destination”
State “Code STEMI”, provide ISBAR notification and ETA
If phone unanswered, request notification of PCI team via GRN to ED
What are the initial steps in treating acute cardiogenic pulmonary oedema?
Universal care with focus on
* Posture
* Oxygenation
* 12 lead ECG
Should clinical support be called for ACPO? What treatments can they provide?
Yes, can perform CPAP and IV GTN
