Chest Pain/ ACS

Question 1

How often should ECG’s be taken in ACS

Answer 1

10-15 mins untill resolved

Question 2

What are potential life-threatening conditions associated with chest pain?

Answer 2

• Aortic dissection
• Pulmonary embolism
• Tension pneumothorax

These conditions should be considered when evaluating a patient presenting with chest pain.

Question 3

How does GTN control the symptoms of ischaemia?

Answer 3

By providing vasodilation and lowering blood pressure

Question 4

Which conditions should we be cautious of when giving GTN in the setting of ACS

Answer 4

Right ventricular infarct and severe aortic stenosis

hypotension in this subgroup can lead to haemodynamic decompensation

Question 5

How many GTN doses should we give before seeking alternate therapies in ACS?

Answer 5

3

Question 6

What are the main issues with administering Opioids in ACS?

Answer 6

Slow gastric emptying and delay absorption of oral therapies

Question 7

Why do we give opioids in ACS?

Answer 7

Reduce sympathetic stimulation and cardiac worload

Question 8

Protocol for ACS treatment

Answer 8

-12 lead ECG within 10 mins
- Oral Aspirin 300mg
-SL GTN 300mcg repeat every 5 min prn

Question 9

Prior to giving GTN in ACS, what are some signs and historic factors we should be cautious of?

Answer 9

Adequate BP,
Rate and Rhythm appropriate
No use of PDE-5 inhibitors

Question 10

4 ways to manage chest pain ACS

Answer 10

SL GTN
IV GTN infusion
IV Fentanyl (preferred to morphine)
IV Morphine

Question 11

Protocol for IV GTN in ACS

Answer 11

Start at 5mcg/min
Increase by 5mcg/min if pain persists
Maintain SBP>100

Question 12

Consider Cardiogenic Shock if these symptoms are present

Answer 12

Cardiac chest pain
AND
Ischaemic ECG changes
AND
SBP<90mmHg

Question 13

Protocol for managing Cariodogenic Shock

Answer 13

Saline up to 250mL given slowly
IF
Responsive to Saline but SBP still <90mmHg repeat 250mL
- Consult if 10mL/kg reached
IF
Unresponsive to Saline give Adrenaline
-Syringe driver at 5mcg/min OR manual infusion at 0.1mcg/kg/min OR bolus 25mcg prn

Question 14

Risk factors for IHD

Answer 14

Diabetes Mellitus
Chronic Renal Failure
Previous PCI, AMI, Coronary Stent or CABG

Question 15

Patient Criteria for Code STEMI

Answer 15

Question 16

ECG Criteria for Code STEMI

Answer 16

Question 17

Transport Criteria for Code STEMI

Answer 17

Question 18

ECG changes needed to be seen in V2-V3 to call anterior STEMI for men >40 years

Answer 18

> 2mm

Question 19

ECG changes needed to be seen in V2-V3 to call anterior STEMI for men <40 years

Answer 19

> 2.5mm

Question 20

ECG changes needed to be seen in V2-V3 to call anterior STEMI for women

Answer 20

> 1.5mm