Cardiac Flashcards
symptom onset < 12 hours and > 1 hr from PCI STEMI managment?
- Time to PCI > 1 hour (PHT endorsed and equipped paramedic) AND
- All inclusion criteria met AND
- No exclusion criteria met
- ALS paramedics MUST call the cardiology consult service prior to progressing to thrombolysis in all cases
- MICA paramedics must call the cardiology consult service where any relative C/I are present
Action
• IV access x 2, Normal Saline TKVO
• Complete checklist and read information statement to Pt
• Tenecteplase IV bolus (see Table 1)
• Heparin IV bolus 4000 IU
- Repeat Heparin IV bolus 1000 IU at 1 hour intervals
• Transport with hospital notification
• Transmit 12-lead ECG to receiving hospital
• Capture a repeat ECG 30 minutes prior
- Time to PCI < 1 hour (PHT endorsed and equipped paramedic) OR
- Does not meet all inclusion criteria OR
- Meets one or more exclusion criteria
• Paramedics should call the cardiology consult service if there is any
uncertainty regarding diagnosis of STEMI or thrombolysis
• ALS paramedics MUST call the cardiology consult service prior to
administering Heparin
• Do not delay transport
Action
• Continue Mx as per CPG A0401 Acute coronary syndrome
• Transport with hospital notification
• Heparin IV bolus 4000 IU
- Repeat Heparin IV bolus 1000 IU at 1 hour intervals
• Capture a repeat ECG 30 minutes prior to arrival and transmit to
receiving hospital with notification
thrombolysis exclusion criteria (MIASMAS - ABG) (10)
- Major surgery in past 3 months
- ICH at any time
- Allergy to Tenectaplase.
- Significant head injury in past 3 months
- Major trauma is past 3 months
- Anti-coagulant therapy
- Stroke or tia in past 3 months
- Allergy to gentamycinn
9 Bleeding disorders - GI or GU bleed in past month
thrombolysis inclusion criteria
Did the symptoms start less than 12 hours ago?
Does the monitor ECG interpretation indicate STEMI or 12-lead ECG shows ST elevation in two or more contiguous leads:
- ≥ 2.5 mm ST elevation in leads V2-3 in men aged <40 years, or
- ≥ 2 mm ST elevation in leads V2-3 in men aged ≥40 years, or
- ≥ 1.5 mm ST elevation in V2-3 in women, or
- ≥ 1 mm in other leads, or
- New onset left bundle-branch block?
thrombolysis relative contras (HALLSTAND-APOA)
HR > 120 bpm? . aged ≥ 75 years?* liver disease? low body weight? SBP > 160 mmHg, traumatic or prolonged (>10 minutes) CPR? anaemia? non-compressible vascular puncture (e.g. recent organ biopsy or IV central line)? DBP >110 mmHg?
acute pericarditis or subacute bacterial endocarditis?
pregnant
one week post-partum?
active peptic ulcer?
how long might it take to see ST segment reduction post thrombolysis and how often does it fail?
upto 60 - 90 minutes; 30% of the time.
what are some complications post thrombolysis>?
bradycardia, tachycardia, poor perfusion, and / or pump failure leading to
cardiogenic shock
CI for CPAP (7)
- GCS < 13
- Facial trauma
- Pneumothorax
- Active vomiting
- Life threatening arrhythmias
- The need for a secure airway
- Hypoventilation
signs of rapidly deteriorating VT pt? (SAIA)
- shock
- altered conscious state
- Ischaemic chest pain
- APO
Pregnant pt > 20 wks cardiac arrest consideration
transport with mCPR; If the patient is pregnant with a known or suspected gestation > 20
weeks and mCPR is available, continue resuscitation and transport
for consideration of resuscitative hysterotomy. The uterus should
be pushed to the left side during transport to minimise aorto-caval
compression (rather than tilting the entire patient to the left)
CPR interfering pt such as gag reflex, interfering or pt aware: fentanyl dose and times
ALS: Fentanyl 25 mcg IV Repeat every 3-5 minutes as required
Heparin CI (8) (BOORKASH)
- Known allergy or hypersensitive
- Active bleeding
- Oral anticoagulants
- Bleeding disorders
- Heparin induced thrombocytopenia
- Severe hepatic impairment
- Oesophagus varicies
- Recent trauma or surgery (< 3/52)
Heparin precaution
- Renal impairment
Heparin side effects
- Bleeding
- Bruising at injection site
- Hyperkalemia
- T
CPAP contras (PVP-FLHG)
- pneumothorax
- vomiting (active)
- pt requires airway mx
- facial trauma
- life threatening arrhythmias
- hypoventilation
- GCS < 13
CPAP precautions (2)
- COPD
2. hypotension
CPAP removal
- HR <50
- Agitation/intolerance of mask
- Nil improvement after 1hr
- Decreasing spO2
- Copius secretions
- Loss of airway control
- Active vomiting
- Pt deterioration
- SBP < 90
- - - GCS < 13
- cardiac/resp arrest
status to initiate rx in cardiogenic apo?
SOB with crackles
status to initiate CPAP in cardiogenic apo?
no improvment with nitrates OR full field APO
Inferior stemi artery
RCA
Anterior stemi artery
LAD
Later stemi artery
Cx
Posterior stemi artery
RCA cx
