Cardiac Ischemia Medical Directive

Question 1

What are the indications?

Answer 1

Suspected cardiac ischemia

Question 2

What are the two medications for cardiac ischemia?

Answer 2

• ASA and Nitroglycerin

Question 3

What are the conditions for ASA?

Answer 3

Age= >18 yrs
LOA= Unaltered
Other= able to chew and swallow

Question 4

What are the conditions for Nitroglycerin?

Answer 4

Age= >18 yrs
LOA= Unaltered
HR= 60-159bpm
SBP= normotension
Other= prior hx of nitro use OR IV access obtained

Question 5

What are the ASA contraindications?

Answer 5

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

Question 6

What are the Nitro contraindications?

Answer 6

• Allergy or sensitivity to nitrates
• Phosphodiesterase inhibitor use within the previous 48 hrs
• SBP drops by 1/3 or more of its initial value after nitro is adminstered
• 12-lead ECG compatible with RV MI

Question 7

What is the treatment for ASA?

Answer 7

• Route= PO
• Dose= 160-162 mg
• Max. single dose= 162mg
• Dosing interval= n/a
• Max. # of doses= 1

Question 8

What is the treatment for nitroglycerin? (No STEMI)

Answer 8

• SBP= >100 mmHg
• Route= SL
• Dose= 0.3mg or 0.4mg
• Max. single dose= 0.4mg
• Dosing interval= 5 min
• Max. # of doses= 6

Question 9

What is the treatment for Nitroglycerin? (STEMI)

Answer 9

• SBP= >100 mmHg
• Route= SL
• Dose= 0.3mg or 0.4mg
• Max. single dose= 0.4mg
• Dosing interval= 5 min
• Max. # of doses= 3

Question 10

What are the clinical considerations?

Answer 10

• Suspected RV MI in all inferior STEMIs and perform a min V4R to confirm (ST-elevation >1mm in V4R)
• Do not administer nitroglycerin to a pt with RV STEMI
• IV condition applies only to PCPs authorized for PCP autonomous IV
• Apply defib pads when a STEMI is identified
• The goal for time to 12-lead ECG from first medical contact is <10 mins where possible