ACLS review

205.  What is the desired door to drug or door to needle time for a patient with STEMI?

If the patient meets the criteria for fibrinolytic therapy, the desired time from the patient presenting to the ER until the beginning of the fibrinolytic therapy is 30 minutes or less.

206.  What are some indications for beginning IV nitroglycerine?

Recurrent or continuing chest pain unresponsive to SL or spray nitroglycerine and morphine

Pulmonary edema complicating STEMI

Hypertension complicating STEMI

207.  Why is nitroglycerine not recommended for patients with a right ventricular infarct?

Patients with acute RV infarction and dysfunction are dependent on maintenacnce of RV filling pressures to maintain cardiac output and blood pressure. Nitrates decrease venous return to the heart and cause a decrease in the right ventricular filling pressures.

208.  What are the therapeutic effects of beta blockers in the treatment of AMI?

Decrease automaticity and arrhythmias

Reduce sinus node discharge

Lower blood pressure

Lower myocardial contractility

Block catecholamine stimulation

Reduce myocardial oxygen consumption

209. After the initial 12 lead ECG, a patient presenting with ACS may be classified into 3 clinical groups.  What are those groups?

ST elevation or new or presumably new BBB: strongly suspicious for injury

ST depression or T-wave inversion: ECG strongly suspicious for ischemia

Non-diagnostic ECG: absence of changes in ST segment or T waves

210.  Unless allergies or contraindications exist, what 4 agents are routinely given to patients with ischemic type chest pain?

Morphine

Oxygen

Nitroglycerin

Aspirin


Reviewed 2/28/16