Acute Coronary Syndrome Flashcard 3

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Rationale

D. Rationale: When an acute coronary syndrome is highly suspected as the cause of cardiac arrest in a recently resuscitated patient, a 12-lead ECG must be obtained right after ROSC to determine if an ST elevation myocardial infarction is present. (Post-Cardiac Arrest Care: Box 4: STEMI or Suspected AMI)

Question

Acute coronary syndrome is suspected in a recently resuscitated patient. What diagnostic test should be ordered?

a. Cardiac MRI
b. Doppler ultrasound
c. Chest X-ray
d. 12-lead ECG

Answer

d. 12-lead ECG

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Rationale

D. Rationale: All of these treatments are important in the treatment of ACS.

Question

Adjunctive treatments used in the treatment of ACS include:

a. IV nitroglycerin
b. Heparin
c. Clopidogrel
d. All of the above

Answer

d. All of the above

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Rationale

C. Rationale: If PCI is the treatment of choice, the first medical contact-to-balloon time should be within 90 minutes. (ACLS Case: Acute Coronary Syndrome)

Question

After assessing a patient in the ED who was brought in due to chest pain, the angiographer decides to perform percutaneous coronary intervention (PCI). If PCI is the treatment of choice, the first medical contact-to-balloon time should be within:

a. 30 minutes
b. 60 minutes
c. 90 minutes
d. Does not matter

Answer

c. 90 minutes

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Rationale

D. Rationale: If PCI is the treatment of choice, the time from first medical contact to procedure should be within 90 minutes.

Question

After assessing a patient in the emergency department who was brought in due to chest pain, the angiographer decides to perform percutaneous coronary intervention (PCI). If PCI is the treatment of choice, the time from first medical contact to procedure should be within:

a. 30 minutes
b. 60 minutes
c. 90 minutes
d. Does not matter

Answer

d. Does not matter

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Rationale

D. Rationale: A full medical history can be delayed until arrival in the ED. However, EMS should obtain a history of the present illness. EMS personnel should administer aspirin, consider oxygen if O2 saturation < 94%, and obtain a 12-lead ECG.

Question

During prehospital care for a patient with ACS, EMS personnel should do all of the following EXCEPT:

a. Administer aspirin
b. Consider oxygen
c. Obtain a 12-lead ECG
d. Obtain a full medical history

Answer

d. Obtain a full medical history

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Rationale

C. Rationale: In acute coronary syndrome, fibrinolytic therapy must be given within 12 hours of the onset of chest discomfort.

Question

EMS has been called to the scene of a patient with sudden crushing chest pain. EMS personnel always ask the patient or family members about the time of symptom onset to gauge 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

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Rationale

C. Rationale: Fibrinolytics should be administered only in the absence of contraindications.

Question

Fibrinolytic therapy is administered to patients with:

a. Symptoms onset within 24 hours of presentation
b. ST segment elevation and suspicion of a true posterior MI
c. The absence of contraindications
d. Only when PCI is not available

Answer

c. The absence of contraindications

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Rationale

B. Rationale: Fibrinolytic therapy in ACS is indicated for patients with ST elevation MI.

Question

Fibrinolytic therapy is indicated:

a. Only within 6 hours of the onset of chest pain
b. For patients with STEMI
c. Only within 12 hours for patients with true posterior MI
d. For patients with nonSTEMI and nondiagnostic ECGs

Answer

b. For patients with STEMI

9 Cards Remain in Deck

Rationale

C. Rationale: Intracranial hemorrhage is the most significant adverse effect of fibrinolytic therapy. (ACLS Case: Stroke)

Question

Fibrinolytic therapy should be given only to select patients for the treatment of ischemic stroke. Otherwise, it may cause more harm than good. What is the most significant adverse effect to avoid when treating a patient with fibrinolytic therapy?

a. Upper GI bleed
b. Intraocular hemorrhage
c. Intracranial hemorrhage
d. Anaphylaxis