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
