Perform CPR. D) 40 beats per minute, Symptoms of bradycardia may include: An upright t-wave in these leads in the setting of ST segment depression is strongly suggestive of posterior wall infarction, as opposed to subendocardial ischemia. Beta-blockers, calcium channel blockers, and ACE inhibitors. Improvement in pain with the administration of the classic GI cocktail is not a reliable indicator that ACS is absent. The signs and symptoms of acute coronary syndrome usually begin abruptly. B) Epinephrine True or False: One type of acute coronary syndrome is Expectant management and prompt airway control when warranted are the mainstays of treatment. This class of agents is also recommended for ACS patients undergoing an initially conservative management strategy who are at high to intermediate risk for ACS. A) Salivates Insight from the 2020 European Society of Cardiology Guidelines. If an individual appears to be unconscious, begin with the BLS Survey, and follow the appropriate pathway for advanced care. B) Right atrium 2. Medication is the only treatment for an unstable tachycardic individual. Providing solid, evidenced-based care is the best thing that ED-based providers can do to contribute to preventing 30 day mortality. D) A facility with trauma care, INCORRECT: A) An appropriate center for triage. C) Adequate perfusion. . In the case of continued angina and hypertension when beta-blockers are contraindicated, a non-dihydropyridine calcium channel blocker, such as verapamil or diltiazem, can be considered. Administer epinephrine. Other ECG-based sequelae of ischemia could include conduction blocks (3 After arrival of an acute stroke individual in the ED, airway (OPA) should only be used on an unconscious individual. Therefore, there remains a population of suspected ACS patients that will not have a definitive diagnosis established with serial biomarkers and ECGs alone. In addition, CMS monitors two outcomes-based measures relative to AMI: 30-day all-cause mortality rates after AMI, and 30-day all-cause readmission rates after discharge for AMI. The SYNERGY trial indicates that crossing over between different pharmacologic agents increases the chances of drug interactions and bleeding risk. This advisory circular (AC) provides information for establishing methods acceptable to the Administrator for compliance with the additional maintenance requirements of Title 14 of the Code of Federal Regulations (14 CFR) part 135, 135.421 for certain air carriers and commercial operators. When using a monophasic defibrillator, how many joules should be delivered per shock? All ACS medications carry a risk profile, whether hemodynamic compromise or increased bleeding risk, and the clinician must balance patient needs and the risk of adverse effects of medication. An ongoing question related to intra-arrest transport and early invasive treatment for refractory OHCA is the timing of when such an approach should be considered. Heart disease, which includes acute coronary syndromes (ACS), is the leading cause of death in the United States. Generally, we initiate aspirin and an ADP receptor antagonist in the setting of high risk ACS in the ED, given that the EARLY ACS trial demonstrated no benefit to upstream initiation vs. cath lab provisional use of eptifibatide. Cocaine use can cause ACS by inducing coronary vasospasm, dissection, thrombosis, positive chronotropic and hypertensive actions, and direct myocardial toxicity (Section 7.10). True or False: A respiratory rate consistently less than 10 or 123. I need all the questions to answer, please Cardiac medications. Individuals experiencing a suspected ACS should be transported to: A center that has a dedicated stroke team. Follow these step-by-step instructions to examine your skin: Face the mirror Check your face, ears, neck, chest, and belly. Administer atropine. narrowed arteries then we can do the procedure immediately . National Heart, Lung, and Blood Institute. A) Delivery Likewise, with right ventricular ischemia/infarction, the reduction in preload produced by nitroglycerin can severely compromise right ventricular function via the Starling curve, and again a precipitous drop in blood pressure can occur. Validated scores include GRACE, PURSUIT, and TIMI models. Hemorrhagic stroke is caused by the rupture of a blood D) Immediately resume CPR and switch to ACLS cardiac arrest algorithm, D) Immediately resume CPR and switch to ACLS cardiac arrest algorithm, Cardioversion should not be delayed if: Vasopressors may be required to provide support until revascularization can be achieved. A reasonable index of suspicion should be maintained for the possibility that the 60 year old with nausea and vague malaise is actually experiencing myocardial ischemia. A) Chest compressions, ventilations D) Magnesium, Bradycardia is defined as any rhythm disorder with a heart rate less than: Which of the following would be your next action if the rhythm is unshockable, and there is no pulse? treating an unknown wide complex tachycardia. This is the percentage of patients with an ED discharge diagnosis of AMI who received aspirin in the ED (or have documented receipt in the 24 hours prior to the ED presentation). If the patient is already hypotensive, is using phosphodiesterase inhibitors, or right ventricular involvement is suspected, nitroglycerin should be avoided. If the initial ECG does not show STEMI, but the patient develops STEMI, this measure will not apply. C) Nitroglycerine Wide or narrow individual with bradycardia and inadequate perfusion For appropriate treatment, it is vital to discern if True or False: Transcutaneous pacing should be used on a bradycardic individual with insufficient perfusion before any other intervention. https://www.nhlbi.nih.gov/health-topics/ischemic-heart-disease. B) 30 minutes B) Give one breath every 5 to 6 seconds, or 10 to 12 breaths per minute. Stress cardiac MRI combines outstanding detail of the cardiac structures with the ability to determine perfusion defects. A) Do not use an AED in water. True or False: Synchronized cardioversion is appropriate for treating an unknown wide complex tachycardia. C. Vasopressin LUNG DISEASE in individuals with sickle hemoglobin is responsible for significant morbidity and mortality. Low risk ACS- negative ECG and biomarkers, low risk per risk stratification tool. vacation. Chest pain or discomfort is the most common symptom. Positive or negative 1 Acute chest syndrome (ACS), characterized by fever and new infiltrates on chest radiograph, is the second most common cause of hospitalization in patients with sickle cell disease and causes 25% of deaths. The individual suddenly deteriorates It is a medical emergency that requires prompt diagnosis and care. The BLS Survey includes assessing which of the following? C) Purkinje system B) Detection a pathologic event. C) The goal of treatment is to identify and correct the underlying cause. However, VQ scanning will not provide information regarding alternate diagnoses, such as occult pneumonia or aortic dissection, that can be discovered on CT. Circulation. Consider accelerated diagnostic protocol, recurrent ischemic chest pain despite ongoing medical management, pulmonary edema or new mitral regurgitation murmur, recent PCI (less than 6 months) or previous CABG, established systolic heart failure (EF<40%), bradycardia (especially with right coronary involvement affecting the sinoatrial pacemaker), back or hip pain, suggestive of potential retroperitoneal hematoma, bleeding at the site of vascular access catheters. Gastrointestinal disorders the alimentary tract can mimic ACS symptoms, with root causes that range from benign (reflux disease) to disastrous (perforated viscera). C) To prevent sepsis Some patients, including the elderly, women, and diabetics, may present with atypical symptoms, including fatigue, abdominal pain, weakness, and nausea in the absence of chest pain. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. B) False Security Consultant with 18 years of intensive experience in Cloud security, Cyber Security, Telecom Security, SDN/NFV, IaC, DevSecOps, Telco Cloud, AWS, Automation & Beyond which has been gained in multiple roles in Cyber/Information security architecture, operations, support, service management, consulting and building enterprise, ISP and Mobile backbone networks. First responders must be aware of and look for signs of ACS. Chest compressions, ventilations Nitroglycerin is effective at ameliorating anginal pain, but this goal should not be pursued at the expense of hemodynamic compromise. Immediately following a shock, CPR should be resumed for how many minutes? A) Atrioventricular block In the setting of a planned interventional strategy where the patient is going to undergo angiography within hours of presentation, it is reasonable to hold off on upstream administration of a GP IIb/IIIa inhibitor until the coronary anatomy is defined and the decision to proceed with PCI has been made. Consider an ACE/ARB in those patients without diabetes or heart failure. A) 30 seconds Lifestyle modification- patients should quit smoking, increase physical activity levels, and maintain a healthy weight. True True or False: 100% oxygen is acceptable for early Recently retired measures include beta-blocker on arrival for AMI. ischemia. You are alone when you encounter an individual in what appears to be cardiac or respiratory arrest. CK should not be used by itself to diagnose MI. All of the following are found within the 8 D's of Stroke Care EXCEPT: All rights reserved. The literature suggests we inadvertently send home 1%-4% of AMI patients from the ED. True statements about AED use in special situations include all of the following EXCEPT: Leave medication patches in place and place the AED electrode pads directly over the patch. These measures apply to patients that are admitted to the hospital directly from the ED. A) Placement of endotracheal tube (ET tube) OP-4: aspirin at arrival: This measure applies both to patients with AMI as well as to patients with chest pain of suspected ACS origin. For a detailed discussion of the evidence supporting each drug and class, see the latest edition of the ACC/AHA guidelines for the management of patients with unstable angina/NSTEMI. False Many of these agents are cleared renally, and dosing should be adjusted in patients with renal insufficiency. It also strongly suggests that dual antiplatelet therapy with aspirin and an ADP receptor antagonist be initiated prior to the use of bivalirudin in the cath lab due to increased rates of ischemic events when bivalirudin was utilized as monotherapy in the ACUITY trial. ST segment elevation myocardial infarction (STEMI) refers to complete or near complete occlusion of an epicardial coronary artery, generally due to atherosclerotic plaque rupture and resultant thrombosis. JCAHO lists serum lipid measurement within 24 hours as a core measure for patients presenting with myocardial infarction. CORRECT: Signs and symptoms of a stroke may include: Myocardial perfusion imaging (MPI) test. A) Maintain blood pressure. It also should be noted that there are no large randomized controlled trials that have demonstrated a reduction in mortality with nitroglycerin use in ACS. Ductal-dependent congenital heart lesions You are alone when you encounter an individual in cardiac arrest. Width of septum What is the only means of identifying ST-elevation MI (STEMI)? This is an assay of limited use in the ED setting, affecting neither diagnosis nor immediate prognosis. See Answer The apparent tortuosity, defined as the ratio of the bulk to the confined self-diffusion coefficients, is found to depend quantitatively on a limited set of material parameters: heat of adsorption, elastic modulus, and percolation probability, all of which are experimentally accessible. A) They account for 50% of all strokes and are caused by an occlusion of a vein to a region of the brain. comatose person during the post-cardiac arrest period? space that results in impaired systemic venous return, impaired A complete blood count. The BLS Survey includes assessing which of the following? . 100% oxygen is acceptable for early intervention but not for extended periods of time. 130 Methamphetamines are also associated with ACS. 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