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NSW Ambulance > Cardiac/Cardiovascular > Flashcards

Cardiac/Cardiovascular Flashcards

1
Q

What is ACS?

A

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

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2
Q

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

A
  • Hypoxaemia
  • Hypovolaemia (including anaphylaxis)
  • Hypo/hyperthermia
  • Hyperkalaemia
  • Tension Pneumothorax
  • Toxins/Drugs/Poisons
  • Thrombosis
  • Tamponade
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3
Q

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

A
  • HPCPR (second officer)
  • confirm code 2 and request backup
  • apply defib pads (first officer)
  • assess rhythm:* SHOCKABLE:
    - defibrillate
    - HPCPR and assess rhythm every 2 minutes
    * administer:
    - adrenaline (repeat every 2nd cycle)
    - amiodarone (ICP only)
    - lignocaine (ICP only)
      * **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
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4
Q

What are the signs and symptoms of cardiogenic pulmonary oedema?

A
  • diaphoresis
  • cough
  • pink, frothy sputum
  • Sudden onset extreme SOB, 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)
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5
Q

What is the treatment for cardiogenic pulmonary oedema?

A
  • 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

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6
Q

What is cardiogenic shock?

A

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

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7
Q

What are the risks for stroke?

A
  • Previous stroke or TIA
  • Obesity
  • Excessive alcohol consumption
  • Atrial fibrillation
  • Hypertension
  • Smoking
  • Diabetes
  • Hyperlipidaemia
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8
Q

What are the 2 treatment windows for stroke?

A

<4.5hr window
<24hr window

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9
Q

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

A

treat signs and symptoms
transport to ED

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10
Q

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

A

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

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11
Q

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

A

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

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12
Q

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

A

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

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13
Q

What are the components of the FAST assessment?

A

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

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14
Q

What are the components of the Hunter 8 stroke score?

A

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

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15
Q

What does the pre morbid modified rankin scale assess?

A

level of disability

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16
Q

What should you include in the handover for stroke Pts?

A

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

17
Q

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

A

treat signs and symptoms
transport to ED

18
Q

What is the treatment for FAST -ve stroke Pts?

A

treat signs and symptoms
transport to ED

19
Q

What are the signs and symptoms of stroke?

A

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 (lack of muscle coordination)

20
Q

What are some conditions of ACS?

A

APO
Angina - stable and unstable
MI
STEMI
STEMI mimic
NSTEMI

21
Q

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

A

continue treatment
transport to ED

22
Q

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

A
  • 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
23
Q

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?

A

Inform Dr
Transport to ED whilst continuing treatment

24
Q

What is the treatment for ACS?

A

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

25
Q

What is the management for STEMI Pts?

A
  • Complete perfusion checklist
  • transmit 12 L (make sure call back phone is on)
  • transport to ED and continue treatments depending on what Dr advises
26
Q

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

A
  • transport to nearest ED with coverage (Coffs)
  • Pre notify via control centre
  • continue treatments
27
Q

What is a cardiac tamponade?

A

Compression of the heart caused by fluid collecting in the pericardium (sac surrounding the heart)

28
Q

What is dysphasia?

A

Difficulty understanding language or difficulty speaking

NSW Ambulance (19 decks)

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