Cardiac Ischemia MD

Question 1

What is the indication for the cardiac ischemia medical directive?

Answer 1

Suspected cardiac ischemia.

Question 2

What are the conditions for ASA administration?

Answer 2

Age ≥18 year
LOA Unaltered
Other Able to chew and swallow

Question 3

What are the contraindications for ASA administration?

Answer 3

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

Question 4

What are the conditions for Nitroglycerin administration?

Answer 4

Age ≥18 years
LOA Unaltered
HR 60-159
SBP Normotension
Other Prior history of nitroglycerin use OR IV access obtained

Question 5

What are the contraindications for nitroglycerin administration?

Answer 5

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

Question 6

What is the dose of ASA?

Answer 6

PO
160-162 mg, 1 dose.

Question 7

What is the dose for nitro for non-STEMI patients?

Answer 7

SL
0.3 or 0.4 mg, max 0.4 mg.
Dosing interval of 5 minutes.
Max 6 doses.

Question 8

What is the dose for nitro for STEMI positive patients?

Answer 8

SL
0.3 or 0.4 mg, max 0.4 mg.
Dosing interval of 5 minutes.
Max 3 doses.

Question 9

What are the clinical considerations for the cardiac ischemia medical directive?

Answer 9

• Suspect a Right Ventricular MI in all inferior STEMIs and perform at minimum V4R to confirm (ST-elevation ≥ 1 mm in V4R)
• Do not administer nitroglycerin to a patient with Right Ventricular STEMI.
• IV condition applies only to PCPs authorized for PCP Autonomous IV.
• Apply defibrillation pads when a STEMI is identified.
• The goal for time to 12-lead ECG from first medical contact is <10 minutes where possible.