Acute Coronary Syndrome Quiz 2

1. 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?

2. 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?

3. A normal or non-diagnostic ECG:

4. 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?

5. 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?

6. 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?

7. 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?

8. According to the ACS algorithm for the management of ischemic chest pain, which intervention is at the center of the decision pathway?

9. 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?

10. 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?