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ALS Medical Directives > Cardiac Ischemia- MD > Flashcards

Cardiac Ischemia- MD Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the indications?

A

suspected cardiac ischemia

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2
Q

What are the conditions for ASA?

A

> = 18 years old
LOA- unaltered
Other - able to chew and swallow

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3
Q

What are the conditions for NITRO?

A

> = 18 years old
LOA- unaltered
HR- 60-159bpm
SBP- normotension
other- prior hx of nitro OR IV access

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4
Q

What are the contraindications for ASA?

A

Ax or sensitivity
If asthmatic, no prior use to ASA
Current active bleeding
CVA OR TBI in the prev. 24 hrs

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5
Q

What are the contraindications for NITRO?

A

Ax or sensitivity
Viagara or (ED) use in the last 48 hours
SBP drops by 1/3 after one dose
12 lead shows RVI (after modified V4R)

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6
Q

What is the treatment for ASA?

A

PO
160-162mg
max dose- 1

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7
Q

After ASA, what is our next course of action? (if you haven’t done it already?)

A

12 LEAD acquisition and interpretation for STEMI

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8
Q

What do we do if we see an inferior STEMI?

A

do a modified V4R to check if there is RVI

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9
Q

What do we do if we see right ventricular involvement?

A

NO NITRO!!!!!

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10
Q

What is the TREATMENT for nitro?

A

STEMI- NO
>=100mmHg
SL
1 spray
0.3 or 0.4 mg
MAX dose- 6 doses

STEMI- YES
>=100mmHg
SL
1 spray
0.3 or 0.4 mg
MAX dose- 3 doses

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11
Q

Once a STEMI is identified what is the first course of action???

A

DEFIB PADS ON!!!

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12
Q

What is the goal time to get a 12 lead ECG from first medical contact is….

A

<10 minutes

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13
Q

When administering NITRO how often should we be taking HR and BP?

A

every 3-5 MINS

interval for NITRO is 5 mins

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14
Q

What is preferred, manual or computer generated interpretation of the ECG?

A

MANUAL

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15
Q

If you are unable to perform a 12 lead ECG within the first 10 mins of pt contact, what do we do?

A

DOCUMENT why you weren’t able to do so!

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16
Q

Why can’t we give NITRO to a pt with and inferior STEMI with RVI?

A

because these pts are often preload dependent meaning that the administration of nitro can cause severe hypotension

17
Q

If you see depression in V1-V4 what should we do?

A

modified 15 lead ECG
(move V4 V5 and V6 to the BACK of the pt)
- possible posterior MI!!

18
Q

If you see a STEMI on the first ECG, how many more ECG’s should you take?

A

NO more! Once a STEMi has been identified, no need to take any more!

19
Q

If you do not see A STEMI in the first ECG, how many more 12 leads should you take and WHEN?

A
  1. Initially ON scene
  2. When in the back of the truck before departing scene
  3. BEFORE you off load pt at the hospital
20
Q

Does the medications that the pt takes PRIOR to EMS arrival count towards our treatment?

A

NO

21
Q

What does prior history of nitro mean?

A

defined has previous authorized or prescribed to the patient for use by a certified medical doctor

22
Q

A patient experiencing a cardiac event (MI) may also likely have a hx of CHF, it can sometimes be difficult to determine what issue is driving the other. If this is the case, how many doses of NITRO should you give? (hint- only go down ONE directive…)

A

3 doses!! follow the cardiac ischemia medical directive and only give 3 sprays MAX

23
Q

What is something else to consider for a pt presenting with a STEMI, but also CHF symptoms (crackles!!!)

A

CPAPPPPPP !!!!!

24
Q

What pts should we be cautious in using nitro for?

A

patients presenting with tachycardia or w SBP close to 100mmHg

25
Q

Is nitro a symptom relief medication?

A

YES.

26
Q

Can you give nitro for an isolated posterior STEMI?

A

yuppppp :)

27
Q

If a patients vitals (they go hypotensive) change between doses of nitroglycerin….. can the pt continue to be given more nitro doses, if the bp goes back UP!!??

A

NO. once the pt has fallen OUT of this directive there is no going back into it

28
Q

What is a common SUFFIX to phosphodiesterase inhibitors? What is the MAIN one we should about too? (also know as erectile dysfunction drugs)

A

-FIL

VIAGARA

29
Q

What is another use of phosphodiesterase inhibitors stated in the companion document?

A

they have diversified to include treatment of pulmonary hypertension and CHF!!!

ALS Medical Directives (12 decks)

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