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Acute Coronary Syndromes Primary goals of therapy for patients with ACS ·          Reduce the amount of myocardial necrosis ·          Prevent major adverse cardiac events ·          Treat acute, life-threatening complications of ACS AMI Symptoms ·          Pain that is more intense than angina and that persists for longer periods of time (eg, longer than 15–20 minutes) ·          Chest discomfort, discomfort in other areas of the upper body, shortness of breath, sweating, nausea, vomiting, and dizziness ·          Atypical symptoms are more common in women, the elderly and diabetic patients. Initial Evaluation ·          Obtain vital signs and oxygen saturation ·          Obtain IV access ·          Obtain 12 lead EKG ·          Perform target history ·          Obtain serum cardiac enzymes, CBC chemistries, and coagulation studies ·          Portable CXR Note:   Ideally within 10 minutes of ED arrival providers should obtain a targeted history while a monitor is attached to the

Identify the following rhythms 1. 2.  3.   4.  5.   Answers Identify the following rhythms 1. Multifocal Atrial Tachycardia  Multifocal Atrial Tachycardia.  The rate is 149.   The rhythm is irregular.  There is an upright P wave before each QRS complex.   The QRS complex is narrow, < .12 sec.   Because the rate is over 100 and there are at least three different P waves of differing morphology, this qualifies the rhythm as a mulifocal atrial tachycardia.  Since this rhythm is ectopic in nature, it probably would not respond to either adenosine or cardioversion.   2. Atrial Fibrillation with RVR Atrial Fibrillation with RVR.  The rate is 150.  The rhythm is irregular.  There are really no identifiable P waves before each QRS complex.  Fibrillatory waves are clearly seen.  The QRS complex is narrow. Because the rate is over 100/min, this rhythm is identified as atrial fibrillation with a rapid ventricular rate.   This r

Identify the following rhythms 1. 2. 3. 4. 5. Answers 1. 1st degree AV block with ventricular trigeminey 2. 2nd Degree AV Block Type II with couplet of PVCs 3. Sinus Arrhythmia with unifocal PVC 4. Sinus Tachycardia with multifocal PVCs 5. Atrial Fibrillation with RVR and multifocal PVCs Reviewed on 3/1/16

Identify the following rhythms: 1. 2. 3. 4. 5. Answers 1. Sinus rhythm with ventricular trigeminy 2. Sinus rhythm with ventricular bigeminy 3. Sinus rhythm with ventricular Quadrigeminy 4. Sinus rhythm with a four beat run of ventricular tachycardia 5. Sinus rhythm with couplets of PVCs Reviewed on 3/1/16

1. 2. 3. 4. 5. Answers 1. Sinus rhythm with a couplet of PVCs 2. Sinus rhythm with multifocal PVCs 3. Sinus rhythm with 6 beat run of VT 4. Sinus rhythm with unifocal PVCs 5. Sinus rhythm with ventricular bigeminy Reviewed 2/28/16

1. 2. 3. 4. 5. 6. Answers 1. Idioventricular Rhythm Idioventricular Rhythm.   The rate is 33.  The rhythm is regular.  There are no P waves before the QRS complexes.   The QRS complex is wide, greater than .12 sec.  A slow rhythm with wide QRS complexes and absent P waves is characteristic of an idioventricular rhythm.  This might be a rhythm that you would see in a patient with PEA.   Recall that with PEA there is a rhythm on the monitor but the patient will be pulseless.   What is the immediate treatment for a patient that is pulseless and apenic?   How do you confirm true pulselessnes in a patient with PEA? What two drugs are indicated in the treatment of PEA?  What are some reversible causes? 2. Bradycardia with Sinus Arrhythmia Bradycardia with Sinus Arrhythmia.    The heart rate is 39.  The rhythm is irregular.   There are upright P waves before each QRS complexes.   The PR interval is .16 sec.   Because of the