Acute Coronary Syndrome Flashcard 2
Rationale
B. Rationale: Morphine produces analgesia and can be used to treat chest pain. When authorized, it can be given to patients that are unresponsive to nitroglycerin.
Question
A 63-year-old man is being treated in the ambulance for an ST elevation acute MI. He has been given nitroglycerin sublingual tablets every 3 to 5 minutes for the past 15 minutes, but his chest pain symptoms have not been alleviated. What is your next consideration?
a. Nitroglycerin
b. Morphine
c. Increase oxygen to 4 L/min
d. NSAIDs
Answer
b. Morphine
Rationale
D. Rationale: When ACS is suspected, and as authorized by medical protocol after determining there is no allergy, the dispatcher can instruct patients to chew aspirin 160–325 mg while waiting for EMS to arrive.
Question
A dispatcher recognizes that a patient is experiencing an acute coronary syndrome at home. What medical intervention can the dispatcher suggest for the patient while awaiting EMS arrival?
a. Oxygen supplementation via nasal cannula at 4 L/min
b. Dispatchers cannot prescribe medicines
c. Apply a nitroglycerin patch
d. Chew aspirin 160–326 mg
Answer
d. Chew aspirin 160–326 mg
Rationale
B. Rationale: Fibrinolytic therapy is not indicated in this instance, and routine use of oxygen is not indicated in the management of ACS.
Question
A normal or non-diagnostic ECG:
a. Should not delay fibrinolytic therapy
b. Represents intermediate or low-risk unstable angina in the setting of chest pain
c. Should be treated with aspirin and oxygen
d. All of the above
Answer
b. Represents intermediate or low-risk unstable angina in the setting of chest pain
Rationale
C. Rationale: In acute coronary syndrome, fibrinolytic therapy must be given within 12 hours of the onset of chest discomfort. (ACLS Case: Acute Coronary Syndrome)
Question
A patient is being treated for a sudden onset of crushing chest pain. EMS personnel always asks fthe patient (or family members) the time of symptom onset to ascertain whether fibrinolytic therapy would still be beneficial for the patient. In acute coronary syndrome, fibrinolytic therapy must be given within how many hours of the onset of chest discomfort?
a. 1 hour
b. 6 hours
c. 12 hours
d. 24 hours
Answer
c. 12 hours
Rationale
C. Rationale: The reperfusion goals for percutaneous coronary intervention procedures should have a goal of 90 minutes from first medical contact.
Question
A patient is brought to the emergency department for an ST elevation MI and is a candidate for percutaneous coronary intervention. What is the upper time limit that this procedure must achieve reperfusion starting from the time of first medical contact?
a. 30 minutes
b. 60 minutes
c. 90 minutes
d. 120 minutes
Answer
c. 90 minutes
Rationale
D. Rationale: The patient’s signs and symptoms, along with the ECG findings, indicate that the patient has a low to intermediate risk of acute coronary syndrome. In this instance, it is prudent to admit the patient for further observation and perform other diagnostic tests such as a stress 2D-echocardiogram or a ⁹⁹ᵐTc-Sestamibi scan.
Question
A patient reporting only retrosternal chest pain has an ECG with nonspecific ST-T wave changes. Symptoms are persistent throughout his stay in the emergency department. What is the next course of action?
a. Fibrinolytic therapy
b. Percutaneous coronary intervention
c. Send patient home
d. Admit patient to observe and perform other diagnostic tests
Answer
d. Admit patient to observe and perform other diagnostic tests
Rationale
C. Rationale: When fibrinolytics are contraindicated, the patient must be prepped for percutaneous coronary intervention.
Question
A patient with a high risk for STEMI is scheduled for fibrinolytic therapy, but he may be ineligible due to treatment with warfarin 5 days ago. What is the next course of action?
a. Continue fibrinolytic therapy.
b. Give adjunctive therapies.
c. Start percutaneous coronary intervention.
d. No further treatment is needed.
Answer
c. Start percutaneous coronary intervention.
Rationale
D. Rationale: The 12-lead ECG is at the center of the decision pathway. It provides the only way of identifying STEMI. Results of the ECG place patients into one of three categories: STEMI, UA/NSTEMI, or low/intermediate risk ACS.
Question
According to the ACS algorithm for the management of ischemic chest pain, which intervention is at the center of the decision pathway?
A. Fibrinolytic checklist
B. Insertion of ET tube
C. Targeted history
D. 12-lead ECG (ECG interpretation)
Answer
D. 12-lead ECG (ECG interpretation)
Rationale
C. Rationale: In ACS, time is of the essence to prevent the progression to cardiac arrest or cardiac death. ED personnel are allotted 10 minutes to perform the initial assessment and management of these patients.
Question
According to the ACS guidelines, once a patient with suspected acute coronary syndrome arrives in the ED, what is the allotted time for ED personnel to perform the initial emergency assessment and management of the patient?
a. 10 seconds
b. 2 minutes
c. 10 minutes
d. 90 minutes
Answer
c. 10 minutes
Rationale
C. Rationale: The proximal left anterior descending artery supplies the anterior, lateral, intraventricular septum, and apex of the left ventricle. Occlusion of the proximal portion of the left anterior descending artery can cause a massive infarction of the said areas. This will affect overall cardiac output, progressing to cardiac arrest and pulseless electrical activity.
Question
Acute coronary syndrome can cause cardiac arrest in pulseless electrical activity if a large portion of the myocardium is affected. What coronary vessel, if occluded by an embolus, can cause cardiogenic shock that will immediately progress into pulseless electrical activity?
a. Posterior descending artery
b. Circumflex artery
c. Proximal left anterior descending artery
d. Right marginal artery
Answer
c. Proximal left anterior descending artery