Cardiac & Respiratory

Question 1

Acute Coronary Syndrome (ACS)

Care Objectives

Answer 1

- Rapid identification of 
  STEMI to facilitate 
  timely reperfusion 
  (PCI or PHT) is the 
  primary goal of 
  prehospital mgmt.

- Provision of anti- 
  platelet Rx (Aspirin).

• Reduce cardiac
  workload by treating
  associated
  symptoms.

Question 2

Why Nitrates are C/I in bradycardia?

Answer 2

HR < 50 bpm due to patient’s inability to compensate for a decrease in venous return by increasing HR to improve cardiac output.

C.O = HR x SV.

Question 3

ACS Mgmt

Answer 3

• Aspirin 300mg oral.

- GTN 300-600mcg S/L 
  if SBP > 110mmHg;
     ~ Lower dose for no 
        previous admin, 
        elderly/frail, 
        borderline BP or 
       = 60kg.
    ~ Repeast initial dose 
      @ 5/60 titrating to 
      pain or s/e.

• GTN patch 50mg
  (0.4mg/hr) upper
  torso/ arms if SBP >
  90mmHg.

- Inadequate response 
  (after x3 doses) or C/I 
  to Nitrates.
     ~ Consider 
        Lignocaine trial.
     ~ Opioids.

Question 4

Bradycardia symptoms

Answer 4

1. Less than adequate perfusion including STEMI/ischaemic pain
2. APO with HR <40
3. VT runs/vent escape rhythm
4. HR <20

Question 5

Asthma Management

Answer 5

Mild/Mod = 4-12 puffs salbutamol at 20min
Severe = 10mg salbutamol repeat 5mg at 5min and Ipratropium bromide 500mcg and 8mg dexamethasone.
No response = adrenaline 500mcg x 3 at 5-10min IM or IV 20mcg at 2min

Question 6

Asthma - unconscious

Answer 6

Ventilate at 5-8breaths/min 6-7ml/kg. Higher PIP and allow for prolonged expiratory phase

Question 7

Asthma - loss of cardiac output

Answer 7

1/60 apnoea
Exclude TpT
No change manage as per cardiac arrest

MICA: carotid pulse with no BP
Adrenaline 50mcg IV repeat 50-100mcg IV @1/60
Normal Saline 20ml/kg