Chest pain, acute coronary syndrome, stemi

Question 1

What are the differential impressions

Answer 1

1. chest pain- cardiac pathology
2. STEMI (st elevation myocardial infraction
3. acute coronary syndrome
4. unstable angina pectoris
5. NSTEMI ( non st elecation myocardial infraction

Question 2

Basic life support actions # 1

Answer 2

universal care line

Question 3

Basic life support actions # 2

Answer 3

Patient safety guideline

Question 4

Basic life support actions # 3

Answer 4

Aspirin 324 mg po (chewable)

WITHOLD FOR PATIENTS W KNOWN CONTRAINDICATIONS

Question 5

Basic life support actions # 3

Answer 5

nitroglycerin .4 mg SL, may repeat every 5 mins for as long as symptoms persist w/out evidence of hypoperfusion

WITHOLD FROM PATIENTS WITH CONTRAINDICATIONS

Question 6

ADVANCED LIFE SUPPORT ACTIONS/CONSIDERATIONS# 1

Answer 6

12 lead ecg

Question 7

If stemi checklist is positve this means

Answer 7

call stemi alert

Question 8

Stemi alert and acute coronary syndrome patients should be transported to what

Answer 8

closest STEMI/ percutaneous coronary intervention facility

Question 9

When should you repeat 12 lead, how often and why.

Answer 9

every 5 min for high index of suspicion of evolving cardiac condition

Question 10

ADVANCED LIFE SUPPORT ACTIONS/CONSIDERATIONS# 2

Answer 10

fluid 10 ml kg iv/io as needed or indicated

• Beware of pulmonary edema in Right ventricular infract and stop if it is present

Question 11

ADVANCED LIFE SUPPORT ACTIONS/CONSIDERATIONS# 3

Answer 11

continuous nitrarte therapy

Question 12

ADVANCED LIFE SUPPORT ACTIONS/CONSIDERATIONS# 4

Answer 12

Pain / anxiety guideline as neccessary or indicated

• FOR SEVERE PAIN UNRESPONSIVE TO NITRO OR INCASES WHERE NITRATES ARE CONTRAINDICATED

Question 13

ADVANCED LIFE SUPPORT ACTIONS/CONSIDERATIONS# 5

Answer 13

nausea and vomiting guidline as necessary or indicated

Question 14

what are the two ways you can call STEMI alert

Answer 14

1. Monitor interpretative statement indicates stemi, has good tracing, stable baseline and free of artifact.
2. Paramedic interpertation- requries all 3below

• Ecg shows 1mm of st segment elevation in 2 or more contiguous leads
• qrs width if less than 120 ms (.12s) or RBBB with st segment elevation
• Ecg good tracing , stable baseline , and free of artifact