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RCE Guidelines Studying > STEMI (CCS 2019 + AHA 2013) > Flashcards

STEMI (CCS 2019 + AHA 2013) Flashcards

1
Q

What is cut off in time in peripheral hospital for deciding to lyse or ship for PCI?

A

120 minutes

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2
Q

What is FMC-STEMI diagnosis target?

A

< 10 minutes

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3
Q

What is PPCI time interval goal?

A

FMC to PPCI < 90 minutes

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4
Q

What is transfer time for PPCI goal?

A

< 60 minutes

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5
Q

What is FMC to needle time target?

A

< 30 minutes

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6
Q

When can PCP crews be used instead of ACP?

A

When patients is stable or when ACP crew not readily available

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7
Q

What is time interval from diagnosis to cath lab activation?

A

10 minutes

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8
Q

What is door in door out time for STEMI in ER

A

30 minutes

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9
Q

What is time from arrival at cath lab to first device deployment?

A

30 minutes

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10
Q

Time from lytic to cath?

A

< 24 hours

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11
Q

What is SPO2 goal in STEMI?

A

> 90 %

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12
Q

Is pre-hospital P2Y12 inhibitor recommended?

A

No, but should be administered as soon as possible in ED

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13
Q

What is recommended anticoagulation in STEMI?

A

UFH

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14
Q

What is recommended AC in patients with history of HIT?

A

Bivalirudin

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15
Q

2 Class 1 indications for pPCI in STEMI and 1 class IIa

A
  • Ischemic symptoms < 12 hours
  • Shock at any time
  • Ongoing ischemia 12-24 hours
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16
Q

When to use BMS? (AHA 2013)

A

When patients can’t tolerate DAPT for 1 year, high bleeding risk.

17
Q

What is UFH dose without GP IIb/IIIa ?

A

70-100 U/kg IV bolus

18
Q

What is Bivalirudin dosing in STEMI?

A

0.75 mg/kg IV bolus then 1.75 mg/kg/h

Reduce infusion to 1 mg/kg/hr if CrCl < 30

19
Q

What AC shouldn’t be used for STEMI?

A

Fondaparinux

20
Q

What is TNK dosing?

A
  • 30mg for < 60kg, 35mg for < 70kg etc

0. 5mg/kg

21
Q

What is TPA dosing?

A

0.75 mg/kg for 30 mins and 0.5 mg/kg over next 60 minutes (90 minutes total)

22
Q

What is dosing of Streptokinase?

A

1.5 million units over 30-60 minutes

23
Q

What is patency rate (Timi 2 or 3) for TNK?

A

85%

24
Q

What are 9 absolute CIs for lytic?

A
  • Prior ICH
  • Known structural cerebral vascular disease (AVM)
  • Malignant IC neoplasm
  • Ischemic stroke < 3 months
  • Aortic Dissection
  • Active bleeding or bleeding diathesis
  • Significant closed-head or facial trauma < 3 months
  • Intracranial or spinal surgery < 2 months
  • Severe uncontrolled hypertension
25
Q

What is 1 absolute CI that is specific to Streptokinase?

A

use within the previous 6 months

26
Q

What is unique about Streptokinase’ Mechanism of action compared to the others

A

It is non fibrin specific

27
Q

What is aPTT target with UFH use?

A

1.5-2.0x

28
Q

How do you decide to give loading dose (300mg) Plavix in lysed patients?

A

Age: If age > 75 you do not give plavix load

29
Q

What is UFH dosing in lysed patients?

A

-60 units/Kg IV bolus followed by 12 units/kg/hr infusion to maintain an aPTT 1.5-2x normal.

30
Q

How to dose Enoxaparin in lysed STEMI if < 75y

A

-30mg bolus and then 1mg/kg q12h

31
Q

Enoxaparin dose in lysed STEMI if age > 75y

A

-No bolus, 0.75mg/kg SC q12h

32
Q

What to do with Enoxaparin dosing if CrCl < 30

A

q24h instead of q12h

33
Q

What are 4 class 1 indications for PCI in patients who were initially lysed?

A
  • Failed
  • Shock/instability
  • Spontaneous or easily provoked ischemia
  • Intermediate or high risk findings on predischarge NIV testing
34
Q

What is Plavix load in patients for PPCI? Lytic for PPCI?

A
  • 600 mg

- 300mg

35
Q

When should Plavix/Ticagrelor be held prior to CABG?

A

24 hours

36
Q

Indications for MRA post STEMI?

A

EF < 40% with either symptomatic HF or DM

37
Q

How long to wait after STEMI for VT to indicate ICD for secondary prevention

A

48 hours with no reversible etiology (ie recurrent arrhythmia)

38
Q

5 risk factors for bleeding with treatment for ACS

A
  • Age > 75
  • Female
  • Diabetes
  • CrCl < 30
  • Chronic use OAC
39
Q

When to evaluate for ICD post MI?

A

40 days post discharge

RCE Guidelines Studying (52 decks)

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