Week 3 Flashcards
What does of Aspirin do you give to a patient with ACS?
300mg
Single dose
Orally
What is the dose of GTN given to suspected ACS patients
300mcg SL is not previously had or elderly/fragile
600mcg SL if had before
+ 50mg patch (0.4mg/hr)
Every 5 mins
No limit
What is aspirin?
Anti platelet aggregator, inhibiting thrombus formation
How long does aspirin last?
Life of the platelet
7-10 days
How long can onset of anti-platelet effects to start of aspirin
45 minutes
What are the contraindications of aspirin?
- Hypersensitivity
- Actively bleeding peptic ulcer
- Bleeding disorders
- Suspected dissecting aortic aneurysm
- chest pain associated with a psychostimulant overdose with BP >160
What are the precautions of aspirin?
- Peptic ulcer
- Asthma
- Patient on anticoagulants
Why is asthma a precaution for aspirin?
It can be a tigger for drug induced asthma
What does GTN do?
Vaso-dilator
- may reduce coronary artery spasm
- Stops nitrates that stimulate Ca2+ release, on smooth muscle in vascular walls
What effect does GTN have on preload and afterload?
Will reduce them both
- Reduces work rate of heart
- Reduce myocardial oxygen consumption
- relieve ischaemia
What are the contraindications for GTN?
- Known hypersensitivity
- Systolic BP <110 - Tablet
- SBP <90 - Patch
- Sildenafil Citrate (Viagra) or Vardenafil (Levitra) in previous 24 hours
- Tadalafil (Cialis) in previous 4 days
- HR >150
HR <50 (excluding autonomic dysreflexia) - VT
- Inferior STEMI with SBP <160
- RV MI
What are the precautions of GTN?
- No previous administration
- Elderly patients
- Recent MI
- Concurrent use with other tocolytics
What are some side effects of GTN?
- Tachycardia
- Hypotension
- Headache
- Skin flushing (vasodilation)
- Bradycardia
When do you use oxygen?
- Only when SpO2 <92
- Shock/hypo-perfusion
What is the does of Ondansetron?
8mg IV
4mg Oral
Why do we give ondansetron to ACS patients?
Prevent vomiting which will increase BP and stress on heart.
Where is lead 1 of a 12 lead ECG placed
4th intercostal space right of sternum
Where is lead 2 of a 12 lead ECG placed
4th intercostal space left of sternum
Where is lead 4 of a 12 lead ECG placed
5th intercostal space left mid clavicular line
Where is lead 6 of a 12 lead ECG placed
left mid auxillary line
on same pane as V4
What is the goal of STEMI management?
minimise ongoing damage and re-perfuse myocardial tissue
What are the methods of STEMI management?
- Thrombolysis
- Primary PCI
- Rescue PCI
What does PCI stand for?
Percutaneous coronary intervention
What are the benefits of PCI?
- Primary PCI offers lower risk of bleeding
- Has higher chance of recanalisation
- Significantly lower chance of re infarction compared to thrombolysis
What is the ideal door to balloon time to increase mortality?
< 120 mins
What does Heparin do?
Inhibits coagulation
What are the contraindications for Heparin?
- Hypersensitivity
- Active bleeding
- Oral anti coagulants
- Bleeding disorders
- History of Heparin-induced Thrombocytopaenia
- Severe hepatic impairment/disease, including oesophageal variances
- Recent trauma or surgery (<3 weeks)
What is tPA?- Activates
Tissue Plasminogen Activator
- activates fibrin specific plasma protein (plasminogen) to become plasmin
- Plasmin is able to break down fibrin
What timelines determine differential treatments in ACS?
> 30 mins to hospital - Thrombolysis
<30 mins - pPCI
