Chest Pain

Question 1

What kind of patient history should you get?

Answer 1

• OPQRST/SAMPLE
• Hx of HTN, hyperlipidemia, smoking, cardiac disease (self/family), obesity
• Hx of MI
• PE risk factors: post-surgery, cancer, birth control use

Question 2

What are some s/s to look for?

Answer 2

• Pain/pressure between umbilicus/jaw/shoulder
• Indigestion, Nausea, vomiting or diaphoresis
• Difficulty breathing
• S/s of CHF
• Syncope or weakness

Question 3

What are the guidelines for SL1?

Answer 3

• General patient care
• Airway management
• Patient positioned comfortably
• Nausea/vomiting protocol

Question 4

What are the guidelines for SL2?

Answer 4

• Aspirin
• Cardiac monitoring and 12 lead EKG
• Nitroglycerin Tablets
• Transport
• Notify

Question 5

What is MI?

Answer 5

Myocardial infarction

Question 6

How much and how should aspirin be administered?

Answer 6

324mg (four 81mg tablets) and should be chewed

Question 7

How often should cardiac monitoring and 12 led EKG be?

Answer 7

Obtain serial EKQs q 10 min, transmit if able

Question 8

When should you give nitroglycerin tablets SL?

Answer 8

if SBP ≥100mmHg and assist the patient with taking medication

Question 9

What is a contraindiacation for NTG?

Answer 9

• If right-side MI is suspected
• SBP < 100mmHg or if Viagra/Levitra has been used in the past 24 hours or Cialis in the last 48hrs

Question 10

Where should the patient be transported?

Answer 10

To a PCI capable facility

Question 11

What does PCI mean?

Answer 11

Percutaneous Coronary Intervention

Question 12

What are the guidelines for SL3?

Answer 12

Vascular access

Question 13

What is STEMI?

Answer 13

ST-Elevation Myocardial Infarction

Question 14

What do you do if a patient s STEMI?

Answer 14

Do not delay transport to establish a second IV

Question 15

When do you perform RT-side EKG?

Answer 15

If hypotensive and/or changes in II, III, and a VL

Question 16

What is contraindication for nitroglycerin with an EKG?

Answer 16

If ST elevation is presenting in right-sided leads

Question 17

When do you perform a posterior EKG?

Answer 17

If ST depressino in V1-V4

Question 18

When do you perform a posterior EKG?

Answer 18

If ST depression in V1-V4

Question 19

When should vasuclar access be established?

Answer 19

Prior to administering subsequent doses of Nitroglycerin

Question 20

Who are atypical or unusual s/s more comon in?

Answer 20

Women, elderly, and diabetic patients

Question 21

When would EMS crewa call a “STEMI Alert”?

Answer 21

When a patient is symptomatic with presumes cardiac related chest pain and new ST segment elevation ≥1mm in two contiguous (anatomical) leads

Question 22

What are the STEMI alert exclusions?

Answer 22

• Patient is asymptomatic for cardiac chest pain but the 12-lead is interpreted as a STEMI
• The patient is symptomatic for cardiac pain and has evidence of:
  
  • Isolated V1 and V2 elevation only
  • LVH
  • LBBB
  • Ventricular/ventricular paced
  • Early repolarization
  • Diffuse St elevation
  • Non-Specific ST changes or poor-quality EKGs