summary 1 Flashcards
acute coronary syndrome
ECG changes for a STEMI
assessment and appraoch
call code STEMI and call seniro for help
A-E assessment
FBC, UEC, troponin, coags, G+S
ROMANCE
R eassure
O2 to maintain sats >94%
M orphine 1-2.5mg IV every 5 minutes to effect
A spirin 300mg
GTN spray (caution if SBP < 100)
Clopidogrel or ticagrelor 180mg (consult local guidelines)
E noxaparin IV (dont give unless specified by cardiology)
definiitive management
definitive management of ACS
mainstay: Percutaneous coronary intervention (PCI): <90 minutes, need to conider renal function and bleeding risk
thrombolysis (alpeplase or tenecteplase) - if cant get PCI <90 minutes (typically rural): conssider contraindications to thrombolysis
ALWAYS discuss disposition: ECG caardiac monitoring on CCU for 48 hours
contraindications to thrombolysis
cranial: haemorrhhagic bleed, recent ischameic stroke or head trauma (<3 months), known cerebral vasculaar lession or mass
active bleeding
suspected aortic dissection
major complications of ACS
A rrythmia: braady, AF, VT, VF
B lood pressure falls: cardiogenic shock
C ardiac failure: APO
D isruption of cardiac muscle: papillary muscle rupture (MR), septal rupture (VSD)
E mbolism: mural thrombus
paroxysmal AF
episodes of AF that last for less than 7 days spontaneously (usually within 48 hours)
parsistant AF
episodes last for more than 7 days
longstanding persistant AF
AF lasting for more than 12 months
permanent AF
refractory to cardioversion and sinus rhythm cannot be restored or mainatined
causes of AF
cardiac: IHD, VHD, HF, HTN
non-cardiac: electrolyte disturbances, thyrotoxicosis, post operative, lung disease (PE/COPD), infections (pneumonia), OSA, alcohol, CKD, diabetes
approach to patient with AF
- heamodynamic stability: A-E approach
- treat the underlying cause of the AF
- anticoagulation: based on CHA2DS2-VASc vs HASBLED
- rate or rhytm control
- address patients other CV risk factors
hheamodynamic stability of the AF patient
A-E
cardiac monitoring
IVC access
definition of instability: shock SBP<90, syncope, ischaemia, heart failure
<48 hours: rhythm control with synchronised DC cardioversion
>48 hours: if anticoagulant for > 3 weeks, urgent synchronised DC cardioversion, if not anticoagulated then TOE guided cardioversion to rule out mural thrmobus then synchronised DC caardioversion
how to treat/investigate the underlying cause of the AF
electrolytes: UEC, CMP
ischaemia: troponin
endocrine: TFTss
structural: echo
anticoagulation for AF
based on CHA2DS2-VASc vs HAS-BLED
you always want to coagulate over bleeding
choce of anticoaagulation: DOAC (apixaban, rivaroxaban, dabigatran)
CHA2DS2-VASc
HAS-BLED score
rate or rhytm control of AF
rate control- beta blockers or central CCBs, digoxin
rhythm control: symptomatic young patient
classfication of chronic heart failure
medical management of heart failure
aetiology of acute decompensated heart failure
compliance: fluid/salt compliance, medication compliance
cardiac/resp: new ACSS, arrhythmia (brady or tacky), PE, acute valvular dysfunction
increased demand: anaemia, infection, hyperthyroidism
investigation forr acute decompensated heart failure
ECG: precipitants (aarrythmia, ACS), signs of LVH
bloods: VBG/ABG, FBC, troponin, BNP
CXR: alveolar oedema, kerrley B lines, cardiomegaly, diversion of upper lobes, effusion
mnagement of acute decompensated heart failure
call for help
A-E
attac monitoring
senior input
LMNOP (in reverse)
P osition (sit upright)
O2: high flow sats <94%
N itrate (GTN IV if SBP>90)
M orphine: if chest pain or agitation
L asix (IV frusemide)
investigationns for COPD
parmacological COPPD management
exacerbation of COPD management
A-E
O2
SABA - salbutamol
wells criteria
causes of raised d-dimer
cancer, CRF, sepsis/infection
post op, trauma
pregnancy
pulmonary embolism management
A-E
anticogulation:
non-massive: SC heparin and NOAC for 3-6 months
submassive: IV UFH (trombolyss no indicated)
masssive: thrombolyssis + IV UFH. consider embolectomy if thrombolysis contraindicated/no sufficient thrmbolysis
transudative pleural effusion
exudative pleural effusion
lights criteria for pleural effusions
plearual effusion management
manage underlying cause
drainage: if asymptomatic then usually recovers by itsself and doesnt need drainage
indications for drainage include: ssymptoms and size, based on clnical judgement
toracentei (needle guided drainage) or chest tube drainage
