Cardiac Conditions (including CHF) Flashcards
CHF patients should be positioned ___________
upright with legs dependent
The only indication for nitroglycerin administration for PCPs is:
Chest discomfort of suspected cardiac ischemic origin
ACS patients who are SOB or in shock require __________(high-flow/low-flow) oxygen therapy
high-flow
Patients who are SOB or in shock require high flow O2. If there is difficulty with the probe acquisition due to patient condition, oxygen should be applied liberally
It is important to have ACS patients chew ASA tablets because __________
it reduces the time of onset
reduces onset from 1 hour to 20 minutes
Nausea is a common symptom of ACS and may be treated by PCPs with __________
Dimenhydrinate, 25-50mg IM or IV
List all ways in which nitroglycerin administration is different for PCPs when the patient does not have a prescription vs. when they do have a prescription:
- Mandatory clinicall consult
- SBP must be maintained above 100mm Hg instead of 90
- HR must be maintained in a range of 50-150 BPM
- Dosing is identical
Onset for Nitroglycerin when delivered as an SL spray is ___
1-3 minutes
ACS patients may receive supplemental oxygen with caution to avoid __________.
hyperoxia
If a PCP administers nitroglycerin without a prescription (following mandatory clinicall consult) it may be given as a 0.4 mg spray SL, q 3-5 minutes provided: Systolic blood pressure of >______ mmHg and a HR of >___ and <___
0.4 mg spray SL, q 3-5 minutes provided:
Systolic blood pressure of >100 mmHg
HR of >50 and <150
If IV access is required in an ACS patient, the _____ (left/right) arm is preferred.
Left
Keep the middle and distal third of right forearm clear to facilitate potential radial artery access for percutaneous coronary artery intervention
ASA exerts its therapeutic effect in ACS by _________
Inhibiting the formation of thromboxane A2 which is a potent platelet aggregate and vasoconstrictor
PCPs _____ (may/may not) administer nitroglycerin to CHF patients without chest discomfort
may not
Two populations who are more likely to present with atypical symptoms of ACS are __________.
Women and people with diabetes
You respond to a 72YO CHF patient with acute pulmonary edema and significant dyspnea. They are alert, able to follow commands and maintain their own airway, tachypneic (RR=32) tachycardic (HR=124) with SBP=84mm Hg, and SpO2=89% on high-flow oxygen. They have significantly increased work of breathing and accessory muscle use. CPAP is __________ (indicated/contraindicated)
contraindicated (SBP <90mm Hg)
This patient is hypotensive and is in cardiogenic shock. CPAP may potenitate further hypotension.
ASA helps to prevent re-occlusion and _____ (will/will not) open the artery.
will not
It has been shown to reduce mortality and is one of the most important early treatments the patient can receive
ACS patients without COPD who appear hemodynamically stable should have oxygen therapy titrated to target an Sp02 of _____
95%
Contraindications to ASA administration are: (list 4)
- Allergy to aspirin or other non-steroidal anti-inflammatory (NSAIDS) agents. This includes many non-aspirin/non-Tylenol pain relievers such as Advil.
- Asthma (see special notes).
- Recent head injury, stroke or acute bleeding (significant) of any kind.
- Pediatric patients with viral symptoms.
- ASA has been linked to Reye’s syndrome in children with a viral history such as chicken pox, or influenza.*
- Asthma – contraindicated in patients who have experienced an exacerbation of their asthma after taking ASA.*
CHF patients with failing respirations should be supported with __________
IPPPV with BVM +/- PEEP
ASA should be given with caution in: (list 5)
- Recent internal bleeding (within last 3 months).
- Known bleeding diseases.
- Patients currently taking anticoagulant agent(s).
- Recent surgery.
- Possibility of pregnancy.
The classic presentation of chest heaviness with radiation to arms or jaw is present in _____% of ACS patients.
30%
CHF patients in respiratory distress may be treated with __________ following a mandatory clinicall consult
CPAP
Adult dosage of ASA is _____
160mg PO
Have the patient chew ASA before swallowing
ACS patients with COPD, especially if on home oxygen, should have their saturation titrated to around_____ (range)
92-95%
Two benefits of CPAP for CHF patients with acute pulmonary edema are:
Improved gas exchange and reduced preload
CPAP acts to prevent alveolar collapse by holding fluid filled alveoli open resulting in improved gas exchange. Increased functioning alveoli allow for improved oxygenation and ultimately decrease the patient’s work of breathing. A secondary benefit of CPAP with CHF patients is the increased pressure in the airways results in an increased intra-thoracic pressure which may help to decrease the volume of blood returning to the congested heart (preload)
ASA _____ (does/does not) typically reduce chest pain in ACS patients
does not
Adult dosage of nitroglycerin for ACS is ____ mg SL, q _____ minutes, provided SBP remains above _____ mm Hg so long as the patient already has a prescription for nitroglycerin.
- 4 mg spray SL, q 3-5 minutes provided systolic blood pressure remains above 90 mmHg
* Consider CliniCall consultation if needing to go beyond 3 doses, for extended transport times, or if patient condition changes/deteriorates markedly*
Entonox _____ (is/is not) an appropriate pain management strategy for patients with chest discomfort and suspected ACS
is
Entonox should not be given within 5 minutes of last NTG administration
Indications for ASA administration in ACS are:
Chest pain or atypical symptoms consistent with cardiac ischemia/AMI
Patients with signs of both CHF (acute pulmonary edema) and hypotension/hypoperfusion are in __________ shock
cardiogenic
These patients are acutely unwell and must be transported to hospital without delay for mechanical support and intervention
Adverse efffects of nitroglycerin administration are: (list 3)
- Hypotension - Do not administer if blood pressure is < 90 systolic or patient exhibits signs of significant hypoperfusion
- Nausea
- Headache
Nitroglycerin __________ (has/has not) demonstrated an improvement in outcomes for ACS patients.
has not!
Nitroglycerin may relieve the pain of angina but will not relieve the pain of M.I. and may well worsen outcomes if it causes hypotension. It is absolutely contraindicated in hypo-perfusing patients with right sided infarcts on ECG as it can cause significant hypotension.
Nitroglycerin should be used with caution in patients with: (list 4)
- Open or closed angle glaucoma
- Hepatic or renal insufficiency.
- Concurrent anti-hypertensive therapy.
- Inferior Myocardial Infarction on 12 lead ECG
PCPs _____ (may/may not) administer nitroglycerin to patients without a presciption.
May
This may only be done following a mandatory consult with CliniCall
Contraindications for nitroglycerin administration are: (list 7)
- Allergy or known hypersensitivity to nitroglycerin or other nitrates
- Viagra or Levitra use in the past 24 hours
- Cialis use in the past 48 hours
- Hypotension or uncorrected hypovolemia
- Severe anaemia
- Constrictive pericarditis and pericardial tamponade
- Right Sided Myocardial Infarction on 12 lead ECG
The primary goal of care in ACS patients is __________
Transport to hospital where the artery can be opened or kept open
