Chest pain

Question 1

STEMI criteria

Answer 1

Onset < 12 hrs
I with ADLs
GCS 15

Question 2

STEMI hospitals

Answer 2

RPH
SCGH
FSH
SJOG Murdoch
? JHC

Question 3

Transmission Criteria

Answer 3

Monitor reading Acute MI or STEMI criteria
ST elevation = 1mm in 2 contiguous limb leads
ST elevation in =2mm in 2 contiguous chest leads
Acute LBBB with chest pain

Question 4

Atypical chest pain presentation

Answer 4

Inter-scapula pain
Epigastric pain
Dizziness, light headedness, transient LOC
Unexplained upper limb/ neck discomfort
N+V no obvious cause
Palpitations/dysrhythmias
weakness/ malaise
Hiccups uncontrolled

Question 5

MI treatment

Answer 5

12 lead - transmit
Aspirin
GTN
Analgesia if GTN has failed to relieve completely- Methoxy/ Fent
PIVC-bloods NOT R wrist
Ondans
Heparin if cath lab approved

Question 6

Pain assessment

Answer 6

Onset
Provocation
Quality
Radiation/ region
Severity
Time

Question 7

GTN intro

Answer 7

Nitrate which causes the relaxation of vascular smooth muscle resulting in:
vasodilation
peripheral pooling and reduced venous return
reduced left ventricular end diastolic pressure (preload)
reduced systemic vascular resistance (afterload)
reduced myocardial energy and O2 requirement
relaxes spasms of coronary arteries

Question 8

GTN indications

Answer 8

chest pain or discomfort or presumed cardiac origin with SBP > 90 mmHg with HR between 50-150bpm
ACPO > 90mmHg
Autonomic dysreflexia > 160mmHg

Question 9

GTN contras

Answer 9

hypersensitivity
hypotension< 90mmHg
VT
Sildenafil, Vardenafil, Avanafil previous 24 hours
Tadalafil previous 3 days

Question 10

GTN dose

Answer 10

400 mcg 5 minutely.
Monitoring BP prior
AD- Cease when BP < 160mmHg

Question 11

Side effects of GTN

Answer 11

hypotension
tachy
flushing
headache
dizziness

Question 12

Aspirin contras

Answer 12

known hypersensitivities aspirin/ salicylates/ NSAIDs
children <16

Question 13

Aspirin intro

Answer 13

minimises platelet aggregation and thrombus formation in order to retard the progression of coronary artery thrombosis

Question 14

Heparin Sodium presentation and administration

Answer 14

5000IU in 5 ml- neat flushed by Nacl

Question 15

Heparin intro

Answer 15

naturally occurring anticoagulant which inhibits the clotting of blood by enhancing the rate at which antithrombin III neutralises thrombin and activated factor X

Question 16

Hep contras

Answer 16

hypersensitivity and active bleeding or disease states with and increased risk of bleeding haemophilia.