Cardiac/Cardiovascular

Question 1

What is ACS?

Answer 1

Acute coronary syndrome is a term that describes a range of conditions related to sudden, reduced blood flow to the heart.

Question 2

What are the reversible causes of cardiac arrest (H’s & T’s)?

Answer 2

Hypoxaemia
Hypovolaemia (including anaphylaxis)
Hypo/hyperthermia
Hyperkalaemia
Tension Pneumothorax
Toxins/Drugs/Poisons
Thrombosis
Tamponade

Question 3

What is the procedure for cardiac arrest (pt unresponsive and no pulse)?

Answer 3

• HPCPR (second officer)
• confirm code 2 and request backup
• apply defib pads (first officer)
• assess rhythm:
• If shockable
  
  • defibrillate
• HPCPR and assess rhythm every 2 minutes
• administer:
• adrenaline (repeat every 2nd cycle)
• amiodarone (ICP only)
• lignocaine (ICP only)
  NOTE: If non shockable:
• HPCPR and assess rhythm every 2 minutes
• administer adrenaline only (repeat every 2nd cycle)
• aim for first rhythm assessment within 2 mins and advanced airway ASAP

Question 4

What are the signs and symptoms of cardiogenic pulmonary oedema?

Answer 4

diaphoresis
cough
pink, frothy sputum
Sudden onset extreme breathlessness, anxiety and feeling of drowning
crackles - in bases and spreading to apices
tachypnoea
tachycardia
hypertension
hypotension (indicates severe left ventricular and cardiogenic shock)
cyanosis (late sign)

Question 5

What is the treatment for cardiogenic pulmonary oedema?

Answer 5

• treat dysrhythmias if present per specific protocol
• CPAP (if indicated and Pt consents) - if don’t consent administer oxygen without CPAP
• oxygen
• GTN
• IPPV with PEEP and 100% oxygen if Pt hypoventilating
• regularly repeat ABCD
• urgent transport to ED

ICP only:
frusemide

Question 6

What is cardiogenic shock?

Answer 6

The heart not pumping enough blood and oxygen to the brain and other vital organs causing hypotension and bradycardia.

Question 7

What are the risks for stroke?

Answer 7

Previous stroke or TIA
Atrial fibrillation
Diabetes
Hyperlipidaemia
Hypertension
Obesity
Smoking
Excessive alcohol consumption

Question 8

What are the 2 treatment windows for stroke?

Answer 8

<4.5hr window
<24hr window

Question 9

What is the treatment for Hyperacute Stroke Mandatory Criteria -ve Pts <4.5 hrs?

Answer 9

treat signs and symptoms
transport to ED

Question 10

What are the further assessments for FAST +ve Pts <4.5 hrs?

Answer 10

Hyperacute Stroke Mandatory Criteria
Pre-morbid function (mRS)
Stoke Severity (Hunter 8)
Complete Stroke Process Sheet

Question 11

What is the treatment for stroke FAST +ve Pts <4.5 hrs & <24hrs?

Answer 11

gain IVC (18G in right ACF preferred)
cardiac monitoring

Consider:
oxygen (92% or less RA)
antiemetic
analgesia

transport to ED - do not delay IV access or ECG

Question 12

What are the 4 components of the hyper acute stroke mandatory criteria?

Answer 12

+ve to any FAST criteria
ED <4.5 hrs from onset/last seen well
Pt >18yrs
BGL 4mmol or greater

Question 13

What are the components of the FAST assessment?

Answer 13

Facial palsy
Arm weakness
Speech impairment/slurring
Time of onset/last seen well

Question 14

What are the components of the Hunter 8 stroke score?

Answer 14

LOC
Commands (eyes, grip etc)
Best gaze
Facial Palsy
Motor arm
Dysarthria
Extinction/neglect

Question 15

What does the pre morbid modified rankin scale assess?

Answer 15

level of disability

Question 16

What should you include in the handover for stroke Pts?

Answer 16

time of onset/last seen well
Any FAST +ve criteria
Stroke process sheet

Question 17

What are the further assessments for FAST +ve Pts <24 hrs?

Answer 17

Pre-morbid function (mRS)
Stoke Severity (Hunter 8)
Complete Stroke Process Sheet

Question 18

What is the treatment for stroke in Pts with onset/last seen well >24hrs?

Answer 18

treat signs and symptoms
transport to ED

Question 19

What is the treatment for FAST -ve stroke Pts?

Answer 19

treat signs and symptoms
transport to ED

Question 20

What are the signs and symptoms of stroke?

Answer 20

May include:
* Weakness or paralysis, especially on one side of the body (hemiparesis/hemiplegia)
* Slurred speech or speech impairment (dysphasia)
* Visual disturbances
* Difficulty swallowing (dysphagia)
* Ataxia

Question 21

What are some conditions of ACS?

Answer 21

APO
Angina - stable and unstable
MI
STEMI
STEMI mimic
NSTEMI

Question 22

What is the treatment for STEMI Pts where the doctor advises not to thrombylise?

Answer 22

continue treatment
transport to ED

Question 23

What is the treatment for STEMI Pts where the doctor advises to thrombylise?

Answer 23

• both paramedics confirm STEMI and Pt meets criteria
• explain risks to Pt and gain consent
• Administer (in order):
  
  • clopidogrel
  • tenecteplase
  • enoxaparin
• Monitor Pt and repeat obs every 15 minutes

minimise time on scene
transport to ED

Question 24

What is the treatment for STEMI Pts where the doctor advises to thrombylise but the Pt does not give consent or they do not meet checklist criteria?

Answer 24

Inform Dr
Transport to ED whilst continuing treatment

Question 25

What is the treatment for ACS?

Answer 25

12L within 10 mins
Aspirin
GTN
Oxygen (if SPO2 <94%)
Fentanyl

Question 26

What is the management for STEMI Pts?

Answer 26

Complete perfusion checklist
transmit 12 L (make sure call back phone is on)
transport to ED and continue treatments depending on what Dr advises

Question 27

What is the treatment for STEMI Pts where the transmission failed?

Answer 27

transport to nearest ED with coverage (Coffs)
Pre notify via control centre
continue treatments

Question 28

What is a cardiac tamponade?

Answer 28

Compression of the heart caused by fluid collecting in the sac surrounding the heart

Question 29

What is dysphasia?

Answer 29

Difficulty understanding language or difficulty speaking