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Paramedic Capstone Subject - QUT > Topic 5 - Chest pain > Flashcards

Topic 5 - Chest pain Flashcards

1
Q

pPCI referral drugs

A
  • Ticagrelor or clopidogrel or nil
  • Heparin
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2
Q

Pre-hospital fibronolysis referral drugs

A
  • Clopidogrel
  • Enoxaparin
  • Tenecteplase

Preference of cardiologist

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3
Q

Bradycardia - Cardiac versus non-cardia

A
  • Cardiac causes are associated with a diseased SA node, AV node or His-Purkinje system
  • Non-cardiac causes are associated with environmental conditions, metabolic or endocrine disorders and toxicology. Treatment of non-cardiac bradycardia should always commence with focus on removing/reversing any causative factors
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4
Q

Bradycardia - management

A
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5
Q

Broad complex tachycardia differentials

A
  • VT
  • SVT with aberrant conduction
    • BBB
    • Intraventricular conduction distrubances
  • Pre-excitation (eg. WPWS)
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6
Q

Broad complex tachycardia management

A
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7
Q

Narrow compex tachycardia - cardiac causes

A
  • SVT - re-entry mechnism caused by:
    • Stimulants
    • Increase in sympathetic tone
    • Electrolyte or acid-base disorders
    • Hyperventilation
    • Emotional stress or pre-excitation syndromes (WPW)
  • Atrial
    • AF
    • Atrial flutter
    • Multiple atrial ectopics
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8
Q

Narrow complex tachycardias - non-cardiac causes

A
  • P waves will be present and tachycardia can result from:
    • Pain/anxiety
    • Hyperthermia/fever
    • Drugs
    • Aneamia
    • Shock
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9
Q

Narrow complex tachycardia management

A
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10
Q

Properties and settings of a diagnostic 12-lead ECG

A
  • Interpratable reading in every lead
  • Setting of 0.05-40Hz for adults
  • 25mm/sec printing speed
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11
Q

Aspirin (Pharmacology)

A
  • Irreversibly inhibit cyclo-oxygenase, reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation) for the life of the platelet.
  • Converted to salicyclic acid in many tissues but primarily the GI mucosa and liver. It is subsequently secreted by the kidneys
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12
Q

Aspirin (Indications)

A
  • Suspected ACS
  • Acute cardiogenic pumonary oedema
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13
Q

Aspirin (Contraindications)

A
  • KSAR or hypersensitivity to aspirin or other NSAIDs
  • Chest pain associated with psychostimulant overdose
  • Bleeding or clotting disorders
  • Current bleeding or peptic ulcers
  • Patients under 18 years
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14
Q

Aspirin (Precautions)

A
  • Possible AA or any other condition that may require surgery
  • Pregnancy
  • Hx of GI bleeding or peptic ulcers
  • Concurrent anticoagulant therapy
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15
Q

Aspirin (Side effects)

A
  • Epigastric pain
  • Nausea and/or vomiting
  • Gastritis
  • GI bleeding
  • NSAID induced bronchospasm
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16
Q

Morphine (Pharmacology)

A
  • Opioid u-receptor binding
  • Metabolised by the liver, kidneys and lungs
17
Q

Morphine (Indications)

A
  • Significant pain
  • Autonomic dysreflexia (with a SBP equal to or over 1600 mmHg)
  • Sedation (CCP ETT)
18
Q

Morphine (Contraindications)

A
  • KSAR or hypersensitivity to morphine
  • Renal failure
19
Q

Morphine (Precautions)

A
  • Elderly
  • Hypotension
  • Respiratory tract burns
  • Respiratory depression and/or failure
  • Known addiction to narcotics
  • Current MAOI therapy
  • Cardiac chest pain
20
Q

Morphine (Side effects)

A
  • Bradycardia
  • Drowziness
  • Hypotension
  • Nausea and vomiting
  • Pin point pupils
  • Respiratory depression
21
Q

QAS special notes on Morphine

A
  • In hypotensice adults patient (SBP <90 mmHg) all incremental doses are not be no greater than 2.5 mg IV or 5mg IM
  • When administering morphine to hypotensive patient, CCPs should be requested
  • IM (preferably) morphine is suitable for labour pain in fill term mothers hovwever some degree of neonatal respiratory depression should be anticipated
22
Q

GTN (Indications)

A
  • Suspected ACS
  • Cardiogenic APO
  • Autonomic dysreflexia (SBP < 160 mmHg)
  • Irukanji syndrome (SBP < 160 mmHg)
23
Q

GTN (Pharmacology)

A

Nitroglycerin mimics endogenoud nitric oxide (NO) which activates guanylate cyclase, resulting in an increase of guanosine 3’5’ monophosphate (cyclic GMP) in smooth muscle and other tissues. This decreases intracellular calcium ion concentration and ultimately smooth muscle relaxation.

24
Q

GTN (Contraindications)

A
  • KSAR or hypersensitivity to GTN
  • HR <50 or >150 bpm
  • SBP <100 mmHg
  • Acute CVA
  • Head trauma
  • Phosphodiesterase inhibitor medication administration in previous 24 hours
25
Q

GTN (Precautions)

A
  • Suspected inferior AMI
  • Cerebral vascular disease
  • Risk of hypotension and/or syncope
  • Intoxication
  • Phosphodiesterase inhibitor use in last 4 days
26
Q

GTN (Side effects)

A
  • Dizziness
  • Hypotension
  • Syncope
  • Reflex tachycardia
  • Vascular headaches
27
Q

STEMI mimics

A
  • LBBB
  • Ventricular pacemaker
  • Ventricular escape rythm
  • Pericarditis
  • Left ventricular hypertrophy
  • Early repolorisation
  • Ventricular aneurysm
28
Q

Contiguous/reciprocal leads

Paramedic Capstone Subject - QUT (12 decks)

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