Cardiovascular EM Flashcards
pharmacologic management of STEMI in the ED
*antiplatelets: aspirin (325 mg) prior to PCI
*nitrates: nitroglycerin (unless RV infarction, hypotension, or hx of severe aortic stenosis)
*anticoagulation: heparin bolus 70-100 mcg/kg
*morphine or fentanyl for pain
*oxygen - only recommended if O2 sat < 90%
reperfusion therapy for STEMI management
*reperfusion therapies include percutaneous coronary intervention (PCI) or fibrinolytics (tPA)
*guidelines:
-if PCI is available: immediate PCI; ideal door-to-balloon time < 90 min
-no on-site PCI:
1. rapid transfer to PCI institution if < 90 min; no fibrinolytics needed
2. if presenting within < 2 hours of sx onset and unable to transfer to PCI center in < 90 min: give full-dose fibrinolytic therapy and transfer to a PCI center
3. if presenting > 2 hours from sx onset, transfer for a primary PCI if able to do so in < 120 min; if not, fibrinolytics may be appropriate up to 12 hours
NSTEMI management in ED
- 325 mg of aspirin
- heparin or LMWH
- sublingual nitroglycerin if continued sx and/or elevated BP
aortic dissection management in ED
*RAPID blood pressure lowering: target 100-120 systolic in < 30 min, HR < 60
*agents of choice: esmolol > labetalol > diltiazem > nitroprusside
*type A is a surgical emergency
atrial fibrillation management in the ED
*rate control options:
1. metoprolol
2. esmolol
3. diltiazem
4. digoxin
5. amiodarone
*cardioversion: cardiovert if paroxysmal A fib; do NOT cardiovert if permanent A fib
