Chest Pain Flashcards
What kind of patient history should you get?
- OPQRST/SAMPLE
- Hx of HTN, hyperlipidemia, smoking, cardiac disease (self/family), obesity
- Hx of MI
- PE risk factors: post-surgery, cancer, birth control use
What are some s/s to look for?
- Pain/pressure between umbilicus/jaw/shoulder
- Indigestion, Nausea, vomiting or diaphoresis
- Difficulty breathing
- S/s of CHF
- Syncope or weakness
What are the guidelines for SL1?
- General patient care
- Airway management
- Patient positioned comfortably
- Nausea/vomiting protocol
What are the guidelines for SL2?
- Aspirin
- Cardiac monitoring and 12 lead EKG
- Nitroglycerin Tablets
- Transport
- Notify
What is MI?
Myocardial infarction
How much and how should aspirin be administered?
324mg (four 81mg tablets) and should be chewed
How often should cardiac monitoring and 12 led EKG be?
Obtain serial EKQs q 10 min, transmit if able
When should you give nitroglycerin tablets SL?
if SBP ≥100mmHg and assist the patient with taking medication
What is a contraindiacation for NTG?
- 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
Where should the patient be transported?
To a PCI capable facility
What does PCI mean?
Percutaneous Coronary Intervention
What are the guidelines for SL3?
Vascular access
What is STEMI?
ST-Elevation Myocardial Infarction
What do you do if a patient s STEMI?
Do not delay transport to establish a second IV
When do you perform RT-side EKG?
If hypotensive and/or changes in II, III, and a VL
What is contraindication for nitroglycerin with an EKG?
If ST elevation is presenting in right-sided leads
When do you perform a posterior EKG?
If ST depressino in V1-V4
When do you perform a posterior EKG?
If ST depression in V1-V4
When should vasuclar access be established?
Prior to administering subsequent doses of Nitroglycerin
Who are atypical or unusual s/s more comon in?
Women, elderly, and diabetic patients
When would EMS crewa call a “STEMI Alert”?
When a patient is symptomatic with presumes cardiac related chest pain and new ST segment elevation ≥1mm in two contiguous (anatomical) leads
What are the STEMI alert exclusions?
- 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
