Cardiac Ischemia, Cardiogenic shock, STEMI bypass

Question 1

What does ASA stand for

Answer 1

acetylsalicylic acid

Question 2

What kind of drug is ASA

Answer 2

Antiplatelet (suppression of normal functioning of platelets)

Question 3

What are the conditions for ASA (under the cardiac ischemia m.d.)

Answer 3

Age ≥ 18 years
LOA unaltered
Other able to chew or swallow

Question 4

What are the conditions for NITROGLYCERIN (under the cardiac ischemia m.d.)

Answer 4

-Age ≥ 18 years
- LOA unaltered
- HR 60-159 bpm
- Normotension
- Prior history of nitroglycerin use OR IV access is obtained

Question 5

What are the 2 drugs that can you can give under the cardiac ischemia medical directive

Answer 5

ASA and nitroglycerin

Question 6

What are the contraindications for ASA (under the cardiac ischemia m.d.)

Answer 6

• Allergy or sensitivity to NSAIDs
• If asthmatic, no prior use of ASA
• Current active bleeding
• CVA or TBI in the previous 24 hours

Question 7

What are the contraindications to NITROGLYCERIN (under the cardiac ischemia m.d.)

Answer 7

• Allergy or sensitivity to nitrates
• Phosphodiesterase inhibitor use within the previous 48 hours
• SBP drops by one-third or more of its initial value after nitroglycerin is administered
• 12-lead ECG compatible with Right Ventricular MI

Question 8

What is the treatment for ACETYLSALICYLIC ACID (under the cardiac ischemia m.d.)?

Answer 8

Route: PO
Max single dose: 162 mg
Dosing interval: N/A
Max # of doses: 1

Question 9

What is the treatment of NITROGLYCERIN (under the cardiac ischemia m.d.)

Answer 9

NO STEMI
- SBP ≥ 100 mmHg
- Route: SL
- Dose: 0.3 or 0.4 mg
- Max single dose: 0.4 mg
- Dosing intervals: 5 min
- Max # doses: 6
YES STEMI
SBP ≥ 100 mmHg
- Route: SL
- Dose: 0.3 or 0.4 mg
- Max single dose: 0.4 mg
- Dosing intervals: 5 min
- Max # doses: 3

Question 10

True or False. Administer nitro to a patient with right ventricular STEMI.

Answer 10

False

Question 11

What does PDEi stand for?

Answer 11

Phosphodiesterase inhibitor

Question 12

Give 5 examples of Phosphodiesterase inhibitors

Answer 12

Viagra
Tadalafil
Levitra
Cialis
Revatio
microdenafil

Question 13

What are the indications for the cardiogenic shock medical directive

Answer 13

STEMI-positive 12-lead ECG
AND
Cardiogenic shock

Question 14

What are the conditions to the administration of 0.9% NaCl fluid bolus (Cardiogenic shock m.d.)

Answer 14

Age ≥ 18 years
SBP: hypotension
Other: Chest auscultation is clear

Question 15

What are the contraindication of 0.9% NaCl fluid bolus (Cardiogenic shock m.d.)

Answer 15

Fluid overload
SBP ≥ 90 mmHg

Question 16

What is the treatment of 0.9% NaCl fluid bolus (Cardiogenic shock m.d.)

Answer 16

Age ≥ 18 years
Route: IV
Infusion: 10 mL/kg
Infusion interval: N/A
Reassess every: 250 mL
Max. volume: 1 000 mL

Question 17

What are the inferior leads

Answer 17

II, III, aVF

Question 18

What are the lateral leads

Answer 18

I, aVL, V5, V6

Question 19

What are the septal leads

Answer 19

V1, V2

Question 20

What are the anterior leads

Answer 20

V3, V4

Question 21

What are the indications for the STEMI bypass protocol

Answer 21

1. Age ≥ 18 years
2. Chest pain or equivalent consistent with cardiac ischemia/myocardial infarction
3. Time from onset of current episode of pain <12 hours
4. 12-lead ECG indicates an acute STEMI
   a. At least 2 mm ST-elevation in leads V1-V3 in at least 2 contiguous leads
   AND/OR
   b. At least 1mm ST-elevation in at least 2 other contiguous leads
   OR
   c. 12-Lead ECG computer interpretation of STEMI and paramedic agrees.

Question 22

What are the contraindication to the STEMI bypass protocol?

Answer 22

Any of the following:
1. CTAS 1 and the paramedic is unable to secure the patient’s airway or ventilate
2. 12-lead ECG is consistent with a LBBB, ventricular paced rhythm or any other STEMI imitator
3. Transport to a PCI centre ≥60 minutes from patient contact
4. Patient is experiencing a complication requiring PCP diversion
a. Moderate to severe respiratory distress or use of CPAP
b. Hemodynamic instability or symptomatic SBP <90 mmHg at any point
c. VSA without ROSC
5. Patient is experiencing a complication requiring ACP diversion
a. Ventilation inadequate despite assistance
b. Hemodynamic instability unresponsive/not amenable to ACP treatment/management
c. VSA without ROSC

Question 23

What drug class is nitroglycerin

Answer 23

vasodilator

Question 24

What are the indications for the cardiac ischemia medical directive

Answer 24

Suspected cardiac ischemia

Question 25

Why don’t you give nitro to a patient with a right ventricular STEMI (inferior)?

Answer 25

• These patients are preload dependent.
• Vasodilators reduce preload.
• Can cause significant hypotension

Question 26

What artery do the septal/anterior leads represent

Answer 26

Left anterior descending artery

Question 27

What artery do the inferior leads represent

Answer 27

Right coronary artery

Question 28

What artery does the high/low lateral leads represent

Answer 28

Circumflex artery

Question 29

Why does it not impact our treatment if the pt took ASA before our arrival?

Like why would u still give ur dose of ASA

Answer 29

• ASA has a wide therapeutic index (effective dose w/o side effects can be 80-1500mg)
• The additional dose provided by paramedics will no exceed the therapeurtic dose.

Question 30

What do we use nitro for? (in cardiac ischemia)

it’s purpose?

Answer 30

Symptom relief

Question 31

What is cardiogenic shock?

Answer 31

• Heart is damaged to an extent in which it’s unable to supply enough blood to the organs, tissues, and cells of the body.