Chest Pain & Respiratory Distress

Question 1

*Differences between STABLE, UNSTABLE, and ATYPICAL ANGINA

Answer 1

• Stable: chest pain w exertion, relative to amt of exertion, improves w rest and nitroglycerin
• Unstable: sxs are worse… an MI waiting to happen. pain more easily provoked by exertion, occurs more requently, longer lived, required more rest and NTG for relief. EMERGENCY- go to hospital to get tx.
• Atypical: occurs at rest

Question 2

*#1 cause of MI

Answer 2

plaque rupture leading to thrombosis of A

Question 3

*MONA is used for?

Answer 3

tx of MI

• morphine
• oxygen
• nitroglycerin
• chewable aspirin

Question 4

*STEMI in V1-V6 means…

Answer 4

Anterolateral L Ventricle MI (most common)

Question 5

*Q waves are affected more so in…

Answer 5

transmural inferior MI’s

not NSTEMI

Question 6

*Prior to cardiac Troponins, the cardiac marker used was…

Answer 6

CK-MB, creatine kinase MB iso-enzyme

was there injury to the HT?

Question 7

*CPR compression-ventilation Ratio

Answer 7

30:2 w/1 -2 rescuers

tx fibrillation w electricity

Question 8

*Aortic Arch Aneurysm/Dissection presents w pain to…

Answer 8

tearing pain between scapula

Question 9

2 Aortic Dissection acute complications mentioned in class…

Answer 9

• —> Acute Renal Failure dt decreased blood to the KDs

- —> Acute Aortic Valve Regurg. if tear is near there

Question 10

An MI can cause _______ which is the MC eti of death after an MI.

Answer 10

Ventricular Fibrillation Arrhythmia

Question 11

MI Sxs

Answer 11

• chest pain
• dyspnea (SOB)
• diaphoresis
• HALF ARE CLINICALLY SILENT or non-classic presentation (FEMALES, DIABETES)

Question 12

*Beck’s Triad is what and used for what?

Answer 12

PE findings in Cardiac Tamponade

1. low BP (can’t return blood to HT efficiently)
2. JVD, acute onset
3. muffled HT sounds

Question 13

• What is Pulsus Paradoxus?

- conditions

Answer 13

nothing to do w PULSE!!

• decreased systolic on inspiration (at least 10mmHg)
• cardiac tamponade, PE, Pericardial Effusion, R Ventricular Failure/Infarction, respiratory failure in asthma

Question 14

Electrical Alternans

Answer 14

alternating shape of QRS complex in amplitude

• seen in cardiac tamponade, pericardial effusion
• wobbling heart in fluid sac

Question 15

*What is Virchow’s Triad?

Answer 15

group of causes that lead to thrombosis and thus PE:

1. alteration in blood flow (bed rest, injury, pregN, obesity, CA)
2. factors within vessel wall (surgery, catheterization)
3. factors affecting coag. of blood (hormones, genetics, deficiencies, smoking, CA)

Question 16

*Differences and Similarities between Well’s Score for PE and DVT:

Answer 16

• PE: clinically suspected DVT, tachycardia, prior Hx of DVT or PE, hemopysis
• DVT: pitting edema, tenderness, swollen leg/calf, superficial veins
• PE and DVT: alt. dx less likely, immobilization/surgery, prior Hx of DVT, CA

Question 17

MC SXS of PE

Answer 17

• feeling of dread
• dyspnea/SOB
• pleuritic chest pain
• cough
• hemoptysis

Question 18

3 D’s (Sxs) in children w Epiglottitis

Answer 18

1. dysphagia
2. drooling
3. distress
   … sitting position w trunk leaning forward, neck hyperextending w chin thrust forward “tripod” position and HOT POTATO voice

Question 19

*Stages of Acute Asthma

Answer 19

1. FEV1 50-80% of norm.; MILD
2. FEV1 50% or less; MODERATE, wheezing, respiratory distress at rest
3. FEV1 25-11%; SEVERE; marked wheezes OR absent breath sounds; mb pulsus paradoxus, SCM contraction
4. FEV1 10% or less; RESPIRATORY FAILURE, lethargy, confusion

Question 20

*During Anaphylactic Shock, are there C/I to Epi? How much?

Answer 20

NO!

IM EPI 0.3-0.5 mg of a 1mg/mL prep

Question 21

*What type of reaction is Anaphylaxis? How is this different from Anaphylactoid?

Answer 21

IgE… loss of vascular integrity, edema of throat/neck, closes airway.. fluid in LU.. decreased vol. in blood –> shock
- Anaphylactoid is non-IgE mediated but resembles anaphylaxis…. often occurs w 1st exposure to certain drugs. Asthma pts at high risk! .. (remember Samter’s Triad: nasal polyps, sens. to ASA, NSAIDS, hay fever)