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Sara's - Medical Directives > Cardiac Ischemia + Cardiogenic Shock AUXILIARY + STEM hospital bypass > Flashcards

Cardiac Ischemia + Cardiogenic Shock AUXILIARY + STEM hospital bypass Flashcards

1
Q

Cardiac Ischemia Medical Directive

What are the INDICATIONS?

What are the top signs/symptoms?

A

Suspected cardiac ischemia

Neck, jaw, Shoulder, arm pain

Tachy

SOB when you are physically active

Nausea and vomiting

Sweating

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2
Q

Cardiac Ischemia Medical Directive

What are the CONDITIONS for ASA?

What does ASA stand for/what does it do?

What are the CONTRAINDICATIONS?

A

Pt has to be GREATER/EQUAL to 18y/o

Pt has to have an unaltered LOA

Pt has to be able to chew and swallow

Acetylsalicylic acid (aspririn) - is an antiplatelet NSAID - clotting

Allergy or sensitivity to NSAIDs

If pt is asthmatic AND no prior use of ASA

Current active bleeding

CVA or TBI in the pervious 24h

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3
Q

Cardiac Ischemia Medical Directive

What are the CONDITIONS for Nitroglycerin?

What is it/What does it do?

What are the CONTRAINDICATIONS?

A

Pt has to be GREATER?EQUAL to 18y/o
AND

Have an LOA unaltered
AND

HR has to be between 60-159bpm
AND

Pt’s SBP has to be normotension
AND

Pt has to have prior hx of nitroglycerin use OR IV access obtained

It’s a vasodilator that relaxes blood vessels to promote blood flow

Allergy or sensitivity to nitrates

Phosphodiesterase inhibitor use within previous 48h

SBP drops by 1/3rd (or more) of its initial value after nitroglycerin is administered

12-lead ECG compatible with right ventricular MI

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4
Q

Cardiac Ischemia Medical Directive

What is the ROUTE and TREATMENT PLAN for ASA?

Is there a TREATMENT PLAN for 12-lead ECG acquisition and interpretation

What is the order of TREATMENT PLANS in this medical directive?

A

Route - PO

Dose - 160mg-162mg

Max.Single Dose - 162mg

Dosing Interval - N/A

Max. # of doses - 1

Yes Consider doing a 12-lead to look for a STEMI BEFORE nitro

ASA - 12-Lead - Nitroglycerin

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5
Q

Cardiac Ischemia Medical Directive

What is the ROUTE , SBP, and TREATMENT PLAN of nitroglycerin for a pt with no STEMI?

Can you administer nitroglycerin to pts with a right ventricular MI?

What is the ROUTE , SBP, and TREATMENT PLAN of nitroglycerin for a pt with a STEMI?

A

Route - SL

SBP - GREATER/EQUAL than 100mHg

Dose - 0.3mg OR 0.4mg

Max.Single Dose - 0.4mg

Dosing Interval - 5min

Max. # of doses - 6

FUCK NO

Route - PO

SBP - GREATER/EQUAL than 100mmHg

Dose - 0.3mg OR 0.4mg

Max.Single Dose - 0.4mg

Dosing Interval - 5min

Max. # of doses - 3

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6
Q

Cardiac Ischemia Medical Directive - Clinical Considerations

What should you suspect and do in all inferior STEMIs?

Who does IV condition apply to?

What should you do for he pt when a STEMI is identified?

A

A right ventricular MI

Perform at minimum V4R to confirm (ST-elevation is ≥ 1mm in V4R)

PCPs authorized for PCP Autonomous IV.

Apply the defibrillation pads

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7
Q

Cardiac Ischemia Medical Directive - Clinical Considerations

What is the time goal to get a 12-lead from first medical contact?

A

Less than 10min where possible

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8
Q

Phosphodiesterase (PDE) 5 inhibitor list?

16

what are many known as?

A
  • Viagra
  • Levitra
  • Cialis
  • Revatio
  • Sildenafil
  • Tadalafil
  • Vardenafil
  • Udenafil
  • Avanafil
  • Lodenafil
  • Mirodenafil
  • Acetildenafil
  • Aildenafil
  • Benzamidenafil,
  • Zaprinast
  • Icariin (a natural product)

Erectile dsyfunciton drugs

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9
Q

Cardiac Ischemia Extra Questions

What other body systems could be considered when assessing for cardiac
ischemia?

Top 4 DDX?

A

HR
RR
Skin Condition
Abdominal(nausea)
Upper body pain (neck/jaw/shoulder)

GERD
Peptic ulcer disease
costochondritis
pleuritis

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10
Q

Cardiac Ischemia Extra Questions

Why does no prior use of ASA if the pt is asthmatic matter as a CONTRAINDICATION?

What’s the danger of active bleeding making it a CONTRAIDICATION for ASA

Why does a CVA/TBI in the previous 24h matter for giving ASA?

A

ASA is known to cause bronchospasm and therfore further the asthma exacerbation

If ASA is given during active bleeding - it inhibits platlet aggregation

^ the bleeding is prolonged

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11
Q

Cardiac Ischemia Extra Questions

What is a PDE-I/why does it matter if the pt has taken any within the previous 48h?

How do you check for 12-lead ECG right ventricular MI?

A

Phosphodiesterase inhibitor
smooth muscle relaxation
vasodilatory
bronchodilatory effects
The drug inhibits cAMP (cyclic AMP)

There is an inferior STEMI with ST elevation in lead III > lead II

V1 is isoelectric while V2 is significantly depressed

There is ST elevation throughout the right-sided leads V3R-V6R

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12
Q

Cardiac Ischemia Extra Questions

Why does ASA come before 12-lead interpretation?

Show me where you would place leads for a 15-lead interpretation?

What should you do if you don’t get a 12-lead on wihtin 10min of the first medical contact of the pt?

A

There is no CONTRAINDICATION (seen in an ECG) for ASA and there are minimal conditions to give the LIFE-SAVING medication.

Document it in your EACR

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13
Q

Cardiac Ischemia Extra Questions

Do you repeat the 12-lead if you identify a STEMI?

What if you don’t find any evidence of a STEMI?

Why can you apply the cardiac ischemia medical directive for ASA as if no care has been provided care prior to you arrival?

A

NO

A serial 12-lead is recommended

Because the paramedics dose does not exceed the theapeutic dose (80-1500mg is the effective dose without side effects)

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14
Q

Cardiac Ischemia Extra Questions

Explain what it means for nitroglycerin when the conditions say “a prior hx OR an established IV’?

Extra (in the companion doc) to say about ^^

A

Prior hx means authorized or prescribed to the pt by a certified medical doctor

An established IV gives you the ability to reverse the negative side effects

IV has to be initiated prior to administration in 1st time cardiac ischemia pts

If there were already an IV then it would need to be inspected

This only applys to PCP Autonomous IV people

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15
Q

Cardiac Ischemia Extra Questions

What does the reduced max number of doses for nitroglycerin in a pt with a STEMI mean?

Does nitroglycerin save the pt? Are there any precaustions?

Can you use CPAP in patients with suspected cardiac ischemia?

A

It reduces the adverse outcomes associated with liberal nitroglyercin use

No it’s a symptom relief

Yes as long as they meet the indications for the continous postive airway pressure medical directive too.

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16
Q

Cardiac Ischemia Extra Questions

Is there any type of STEMI you can administer nitroglycerin for?

Can you administer ASA if the patient’s symptoms resolve prior to your arrival?

A

Yes, an isolated posterior STEMI

Yes, you can assess the pt and make a clinical judgment to do so, maybe call BHP too.

17
Q

Cardiac Ischemia Extra Questions

What do you do if the patient’s vital signs fall outside of the conditions for nitroglycerin?

Why

AND what if the patient’s vital signs fall back to within the conditions?

A

Then the pt can no longer receive it nitro

All because of the risk of reacurrent decompensation (likely hypotens)

Still can’t receive it

18
Q

Cardiogenic Shock Medical Directive - AUXILIARY

What are the INDICATIONS?

You can only provide medical treatment in this medical directive IF ??

What does a patient with cardiogenic shock present as?

A

STEMI-positive 12-lead ECG
AND
Cardiogenic shock

If you are authorized for PCP autonomous IV

Rapid breathing - SOB

Sudden, rapid heartbeat (tachycardia), weak pulse

Loss of consciousness

Low blood pressure (hypotension)

Sweating and pale skin

19
Q

Cardiogenic Shock Medical Directive - AUXILIARY

What are the CONDITIONS for 0.9%NACl Fluid Bolus?

What are the CONTRAINDICATIONS?

A

Pt has to be GREATER/EQUAL then 18y/o

Pt has to have hypotension

Pt’s chest auscultation has to be clear

Fluid overload

SBP is GREATER/EQUAL to 90mmHg

20
Q

Cardiogenic Shock Medical Directive - AUXILIARY

What is the AGE, ROUTE, and TREATMENT PLAN for 0.9%NACl if available and authorized?

Examples of fluid overload

A

Age - GREATER/EQUAL to 18y/o

Route - IV

Infusion - 10mL/kg

Infusion Interval - N/A

Reassess every - 250mL

Max. Volume - 1,000mL

  • Rapid weight gain
  • Noticeable swelling (edema) in your arms, legs and face
  • Swelling in your abdomen
  • Cramping, headache, and stomach bloating
  • Shortness of breath
  • High blood pressure
21
Q

Cardiogenic Shock Medical Directive - AUXILIARY

Define cardiogenic shock for me

True or false - a 10ml/kg 0.9%NACl fluid bolus may be administered to a maximum of 1,000ml to reflect to need for preload rather than an intervention for volume depletion?

A

a state in which the heart has been damaged to such an extent that it is unable to supply enough blood to the organs, tissues, and cells of the body

True

22
Q

STEMI

What is the STEMI criteria on an ECG?

A

≥1mm ST segment elevation in at least two limb leads
* I, AVL
* II, III, AVF
≥ 2mm ST segment elevation two or more contiguous precordial leads
* V1-V3
≥ 1mm ST segment elevation two or more contiguous precordial leads
* V4-V6
≥ 2mm ST segment elevation in V2 & V3 is contiguous if not enough elevation in V1 or V4

23
Q

STEMI - reciprocal changes

P.A.I.L.S

Show me the leads and which artery supply what area?

What are the major arteries that supply the heart?

A

The reciprocal changes are expected to appear in the adjacent zones

RCA - Right coronary artery
LAD - Left Anterior Descending Artery
Circ. - Circumflex artery

24
Q

STEMI Hospital Bypas Protocol

What are the INDICATIONS?

Transport where?

If the patient meets any of these and there ECG normalizes what do you do?

A

≥18 years of age

Chest pain or equivalent consistent with cardiac ischemia or myocardial infarction

Time from onset of the current episode of pain < 12 hours

12-lead ECG indicated an acute myocardial infarction/STEMI as follows:
* At least 2 mm ST-elevation in leads V1-V3 in at least two contiguous leads
AND/OR
* At least 1 mm ST-elevation in at least two other anatomically contiguous leads
OR
* 12-lead ECG computer interpretation of STEMI and paramedic agrees

To a PCI centre

Just keep following the STEMI protocol

25
Q

STEMI Hospital Bypas Protocol

What are the CONTRAINDICATIONS?

5 (2 of which have 3)

What can the interventional cardiology program do?

A

The patient is CTAS 1 and paramedic is unable to secure patient’s airway or ventilate

12-lead ECG is consistent with LBBB, ventricular paced rhythm, or any other STEMI imitator

Transport to a PCI centre is ≥60 min from pt contact

Patient is experiencing a complication requiring PCP diversion, as follows:
* Moderate to severe respiratory distress or use of CPAP
* Hemodynamic instability or symptomatic SBP LESS than 90 mmHg at any point
* pt is VSA without ROSC

The patient is experiencing a complication requiring ACP diversion, as follows:
* Ventilation inadequate despite assistance
* Hemodynamic instability unresponsive to advanced care paramedic (ACP) treatment or not amenable to ACP management
* pt is VSA without ROSC

They can still permit the transport of the patient to the PCI centre.

Sara's - Medical Directives (16 decks)

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