Khalid Review Flashcards
What are the intial steps in management of a patient with ACS?
oxygen via nasal cannula
pain relief with opiate or nitro
aspirin
ECG
If ECG shows NSTEMI, what should their treatment plan be?
aspirin P2Y12 inhibitor anticoagulation therapy beta blockers ACEI NO thrombolytics
What should be avoided in NSTEMI patients
Fibrinolytic/thrombolytic therapy
What are the two most common antiplatelet agents used for ACS?
clopidogrel
ticagrelor
What are the two most common anticoagulant therapies?
IV Heparin
fondaxaparin
What are the indications for PCI/coronary angiography?
recurrent angina at rest or with low level activity
elevated troponin or ST segment depression
recurrent ischemia with HF
High risk stress test result
if you can do immediate PCI, what is the time frame for doing so?
90 minutes or less
If you have to transfer a patient to another hospital for PCI, what is the time frame for doing so?
120 minutes.
If you cannot transfer the patient to another hospital for PCI, what do you administer?
thrombolytic therapy
When is thrombolytic therapy indicated?
acute STEMI
What are the contraindications for thrombolytic therapy?
previous hemorrhagic stroke
other stroke within a year
known intracranial neoplasm
recent head trauma
active internal bleeding
suspected aortic dissection
What are some post MI complications?
post infarction ischemia
arrhythmia
RV infarct
mechanical complications
myocardial dysfunction
What arrhythmia is most common in inferior post-MI?
sinus bradycardia
In a patient post - MI with a fib, what do you use to treat them?
metoprolol
CCB if can’t use BB
if still unstable, electrical cardioversion
How do you treat an AV block?
pacemaker
What is most common in the first few hours of an MI?
ventricular arrhythmia
How to treat a patient with hemodynamically unstable v tach?
defibrillation
How to treat a patient with stable V tach?
amiodarone
What complication can be see 3-7 days after an acute MI?
papillary muscle rupture
What PE finding will you see in a patient with a post MI papillary muscle rupture?
new systolic murmur - mitral regurgitation or VSD murmur.
mitral - heard apically
VSD - heard parasternally
What post MI complication presents with hypotension, pulmonary edema and no response to fluid resuscitation ?
myocardial dysfunction
What is cardiogenic shock?
systolic BP < 90 and signs of diminished perfusion (cold extremities, decreased UOP, confusion)
How do you treat a patient with cardiogenic shock?
IV diuretics in less sick pts
dopamine, dobutamine, NE
What is the triad for septic shock?
sepsis
hypotension fluid unresponsive
serum lactate levels >2 mmol and a need for vasopressors
