Cardiac Ischemia- MD Flashcards
What are the indications?
suspected cardiac ischemia
What are the conditions for ASA?
> = 18 years old
LOA- unaltered
Other - able to chew and swallow
What are the conditions for NITRO?
> = 18 years old
LOA- unaltered
HR- 60-159bpm
SBP- normotension
other- prior hx of nitro OR IV access
What are the contraindications for ASA?
Ax or sensitivity
If asthmatic, no prior use to ASA
Current active bleeding
CVA OR TBI in the prev. 24 hrs
What are the contraindications for NITRO?
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)
What is the treatment for ASA?
PO
160-162mg
max dose- 1
After ASA, what is our next course of action? (if you haven’t done it already?)
12 LEAD acquisition and interpretation for STEMI
What do we do if we see an inferior STEMI?
do a modified V4R to check if there is RVI
What do we do if we see right ventricular involvement?
NO NITRO!!!!!
What is the TREATMENT for nitro?
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
Once a STEMI is identified what is the first course of action???
DEFIB PADS ON!!!
What is the goal time to get a 12 lead ECG from first medical contact is….
<10 minutes
When administering NITRO how often should we be taking HR and BP?
every 3-5 MINS
interval for NITRO is 5 mins
What is preferred, manual or computer generated interpretation of the ECG?
MANUAL
If you are unable to perform a 12 lead ECG within the first 10 mins of pt contact, what do we do?
DOCUMENT why you weren’t able to do so!
Why can’t we give NITRO to a pt with and inferior STEMI with RVI?
because these pts are often preload dependent meaning that the administration of nitro can cause severe hypotension
If you see depression in V1-V4 what should we do?
modified 15 lead ECG
(move V4 V5 and V6 to the BACK of the pt)
- possible posterior MI!!
If you see a STEMI on the first ECG, how many more ECG’s should you take?
NO more! Once a STEMi has been identified, no need to take any more!
If you do not see A STEMI in the first ECG, how many more 12 leads should you take and WHEN?
- Initially ON scene
- When in the back of the truck before departing scene
- BEFORE you off load pt at the hospital
Does the medications that the pt takes PRIOR to EMS arrival count towards our treatment?
NO
What does prior history of nitro mean?
defined has previous authorized or prescribed to the patient for use by a certified medical doctor
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…)
3 doses!! follow the cardiac ischemia medical directive and only give 3 sprays MAX
What is something else to consider for a pt presenting with a STEMI, but also CHF symptoms (crackles!!!)
CPAPPPPPP !!!!!
What pts should we be cautious in using nitro for?
patients presenting with tachycardia or w SBP close to 100mmHg
Is nitro a symptom relief medication?
YES.
Can you give nitro for an isolated posterior STEMI?
yuppppp :)
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!!??
NO. once the pt has fallen OUT of this directive there is no going back into it
What is a common SUFFIX to phosphodiesterase inhibitors? What is the MAIN one we should about too? (also know as erectile dysfunction drugs)
-FIL
VIAGARA
What is another use of phosphodiesterase inhibitors stated in the companion document?
they have diversified to include treatment of pulmonary hypertension and CHF!!!
