Cardiac

Question 1

Mx for ACS

Answer 1

Aspirin 300mcg
GTN PO + patch
Opioid pain relief
STEMI Mx if onset <12 hrs

Question 2

Acceptable BP for GTN

Answer 2

> 110 for tablet

>90 for patch

Question 3

How often do you give GTN for ACS?

Answer 3

Every 5/60 titrated to pain or side effects

Question 4

Steps of modified valsalva (4)

Answer 4

Position semi-recumbent 45• angle
Forced expiration for 15 seconds
Immediately lay flat with legs raised to 45• for 15 seconds
Return to semi-recumbent

Question 5

What BP is acceptable for valsalva?

Answer 5

90+

Question 6

Goals of care for stable SVT (3)

Answer 6

MICA
12-lead ECG
Valsalva

Question 7

How many attempts at valsalva?

Answer 7

Max 3

Question 8

What’s the time between valsalva attempts?

Answer 8

2 minutes

Question 9

Contraindications for CPAP (7)

Answer 9

GCS <10
Facial trauma
Pneumothorax
Active vomiting 
Life threatening arrhythmias 
Need for secure airway 
Hypoventilation

Question 10

When can ALS use CPAP?

Answer 10

APO without improvement Post GTN, or full field crackles

Question 11

Mx for APO (SOB and crackles)

Answer 11

GTN PO + patch

CPAP if no improvement or full field

Question 12

How often is GTN given for APO?

Answer 12

Every 5 minutes titrated to pain or side effects

Question 13

Heparin dose for STEMI and time intervals

Answer 13

IV bolus 4000 IU

Repeat 1000 IU every hour

Question 14

Which patients get IV heparin?

Answer 14

STEMI with symptom onset <12 hrs

Question 15

Which patients get tenecteplase?

Answer 15

STEMI patients with symptom onset <12 hrs, time to PCI >1 hr, meet all inclusion criteria and no exclusion criteria