For individuals with acute coronary syndrome (ACS), proper care starts during the call to EMS. Active. Guedeney P, et al. Indications for transcutaneous pacing (TCP) include all of the following EXCEPT: Bradycardia with symptomatic ventricular escape rhythms. B) Obtain normal sinus rhythm. Symptoms suggestive of ACS may include all of the following EXCEPT: *Headache and blurry vision Chest discomfort with lightheadedness, sweating, or nausea Unexplained shortness of breath with or without chest discomfort Uncomfortable pressure in the center of the chest CORRECT What is the only means of identifying ST-elevation MI (STEMI)? B) Metoprolol Which of the following may be essential to maintain an individual's airway open? Initial evaluation and management of suspected acute coronary syndrome (myocardial infarction, unstable angina) in the emergency room. Are pain-free, but have had chest pain in the last 12 hours and have an abnormal electrocardiogram (ECG) or an ECG is not available. AMI 7: median time to fibrinolysis: This measure applies to patients with STEMI or new left bundle branch block (LBBB) on the initial ECG that receive fibrinolytics as the primary treatment. If IV access is not available, the next preferred route is: The two most common and easily reversible causes of PEA are: The cardiac arrest rhythm associated with NO discernible electrical activity on the ECG is termed as _________? D) Defer cardioversion until symptoms become irreversible. It also strongly suggests that dual antiplatelet therapy with aspirin and an ADP receptor antagonist be initiated prior to the use of bivalirudin in the cath lab due to increased rates of ischemic events when bivalirudin was utilized as monotherapy in the ACUITY trial. Patients with a low risk for ACS, as characterized by a low risk stratification score, but not clearly non-cardiac chest pain, should undergo an accelerated diagnostic protocol in an observation setting, including serial evaluations such as biomarkers and ECG. The 2015 JRC guidelines suggest withholding routine high-concentration oxygen supplementation (8 L/min) in normoxic (SpO 2 > 93%) patients with ACS (weak recommendation, very low-quality evidence), except for patients with previous myocardial infarction, severe chronic obstructive pulmonary disease, respiratory failure, cardiogenic shock, central EXCEPT: All heart tissue immediately dies when an individual enters These medications should be avoided in patients with pre-existing hypotension or cardiogenic shock. At the individual level, patients should be advised to chew a nonenteric coated aspirin (162 to 325 mg) at first recognition of ACS symptoms, unless they have a history of severe aspirin . Scribd is the world's largest social reading and publishing site. By 1867, the society had sent more than 13,000 emigrants. rhythm? Generally, acute plaque rupture with downstream thrombus showering will manifest itself with elevated biomarkers. Antiplatelet agents work on the various receptors on the platelet surface to inhibit successful platelet aggregation, whereas anticoagulants will target the thrombin-fibrin cascade along different points, depending on the agent. The increased sensitivity and accuracy over conventional stress imaging is tempered by the restricted availability of this technology. Thirty ____________ and two ____________ equal one cycle of CPR. Other ECG-based sequelae of ischemia could include conduction blocks (3 Individuals experiencing a suspected ACS should be transported to: An appropriate center for triage A center that has a dedicated stroke team A facility with trauma care A facility that performs PCI In a bradycardic individual who is symptomatic and does not respond to atropine, the next treatment to consider is: Analgesics Transcutaneous pacing the QRS wave is ___________in a tachycardic individual. 2. Low risk ACS- negative ECG and biomarkers, low risk per risk stratification tool. The mechanism of this relationship has not been defined, but it is postulated that opiate use may mask identification of recurrent ischemia. Elevated creatinine has also been identified as a risk factor for adverse outcome in ACS. It is a medical emergency that requires prompt diagnosis and care. The correct option is b) if tachycardia is causing the 1 Acute chest syndrome (ACS), characterized by fever and new infiltrates on chest radiograph, is the second most common cause of hospitalization in patients with sickle cell disease and causes 25% of deaths. Gastrointestinal disorders the alimentary tract can mimic ACS symptoms, with root causes that range from benign (reflux disease) to disastrous (perforated viscera). All patients presenting with suspected ACS should receive 162-325 mg of aspirin unless they are allergic. Airway, Breathing, Circulation, Differential Diagnosis. Overview of acute coronary syndromes. D) Albuterol, What is the first step in the treatment of persistent tachycardia (heart rate > 150 bpm) causing hypotension, altered mental status, and signs of shock? True or False: Transcutaneous pacing is recommended for http://www.heart.org/HEARTORG/Conditions/HeartAttack/%20PreventionTreatmentofHeartAttack/Cardiac-Medications_UCM_303937_Article.jsp#.XG37pKJKjIU. However, factor Xa assays can be used if available and necessary to assess the extent of anticoagulant activity provided by LMWH. Therefore, our protocol utilizes early administration of dual platelet therapy so as to ensure adequate inhibition as soon as possible. C) Purkinje system A) Chest compressions, ventilations In a bradycardic individual who is symptomatic and does not Please login or register first to view this content. B) 20:01 If the patient was transferred from another hospital, designated as comfort care only, or if there are explicitly documented reasons for a delay (cardiac arrest, patient refusal, diagnostic uncertainty regarding the STEMI), the measure will also not apply. Current troponin assays in clinical use are substantially more sensitive than previous iterations, and are detectable in the first few hours after infarction. This is an assay of limited use in the ED setting, affecting neither diagnosis nor immediate prognosis. This content does not have an Arabic version. in what time frame should an assessment and an order for a CT scan TRUE The ACLS Survey includes assessing which of the following? However, a plaque that is substantial enough to cause ischemic symptoms and consequences, but not actual infarction and cell death, will not be detected by a single troponin drawn after the onset of symptoms. False 2. B) True or False: One type of acute coronary syndrome is STEMI. You are alone when you encounter an individual in cardiac arrest. Journal of Clinical Medicine. D) Administer a calcium channel blocker. pollution permits? In addition, CMS monitors two outcomes-based measures relative to AMI: 30-day all-cause mortality rates after AMI, and 30-day all-cause readmission rates after discharge for AMI. 54. This is an example of what type of heart According to the 2015 Guidelines, stopping chest compressions for any reason, such as pulse checks, should be limited to less than: Which of the following would be your next action if the rhythm is unshockable, and there is no pulse? C) Below 100 bpm C) Positive or negative If the AED advises no shock, you should still defibrillate because defibrillation often restarts the heart with no pulse. Which wave represents repolarization of the ventricles? If the previous testing was a functional study (stress echo), consider a perfusion (cardiac MRI, nuclear perfusion) or an anatomic study (coronary CT, cardiac catheterization), and vice versa. C) Left atrium and right ventricle Ventricular fibrillation All of the following are categories of unstable angina EXCEPT: D. Both A and B (The individual suddenly deteriorates & The individual becomes pulseless). A) Vital organs can be permanently damaged. Which of the following functionality can NOT be developed using These measures apply to patients that are admitted to the hospital directly from the ED. D) Defibrillation, Thirty ____________ and two ____________ equal one cycle of CPR. If the initial ECG does not show STEMI, but the patient goes on to develop STEMI, this measure will not apply. False If bradycardia (heart rate less than 60 beats per minute) with This content does not have an English version. For patients receiving unfractionated heparin infusion, partial thromboplastin time (PTT) should be monitored while on the infusion so infusion rates can be adjusted to therapeutic effect. This class of oral medications includes thienopyridines (clopidogrel, prasugrel) as well as the non-thienopyridine agent ticagrelor. All of the following are considered classic symptoms of an acute stroke EXCEPT: Upon assessment, the individiual is confused and complains of a headache and the left side of his body being numb. Patients without high risk features but with increased risk for ACS as characterized by a validated risk stratification score may be managed utilizing an initially conservative strategy and diagnostic protocol. The care of patients transferred to another hospital for inpatient care must meet the standards set by the Hospital-Outpatient metrics, discussed below. Individuals experiencing a suspected ACS should be transported to: A center that has a dedicated stroke team An appropriate center for triage A facility that performs PCI A facility with trauma care This problem has been solved! Evidence suggests that PCI can be performed safely with LMWH, without a transition to UFH. STEMI is defined by >1mm/0.1mV elevation of the ST segment in two or more contiguous leads on an ECG. This is the percentage of ED patients over the age of 40 with a diagnosis that includes non-traumatic chest pain who received a 12-lead ECG. False Time between symptoms onset and time of arrival at an ED are INCORRECT: The probability of successful defibrillation decreases quickly over time. B) Right atrium Which of the following is correct regarding individuals with acute stroke? Synchronized cardioversion is appropriate for treating an unknown wide complex tachycardia. B) 60 beats per minute wave is ___________in a tachycardic individual. D. Both B and C, Individuals experiencing a suspected ACS should be transported to: Death of the myocardial tissue is progressing in STEMI, and worsens the longer reperfusion is delayed. A) Defibrillation OP-5: median time to ECG: This measure applies both to patients with AMI as well as to patients with chest pain of suspected ACS origin. How should the results be interpreted? The ACLS Survey includes assessing which of the following? endstream endobj 1 0 obj <> endobj 2 0 obj <>stream Explain why these are true or false. Open navigation menu asystole. False The strongest recommendation the authors can make is for the emergency department and cardiology teams to sit down and determine an explicit protocol as to which drugs will be used in which patients, based on clinical presentation. A) Identify and reverse etiologies of the arrest For appropriate treatment, it is vital to discern if the QRS ventricle True Despite its potential adverse physiological effects, supplemental oxygen continues to be administered to almost 90% of patients with suspected ACS. Cocaine use can cause ACS by inducing coronary vasospasm, dissection, thrombosis, positive chronotropic and hypertensive actions, and direct myocardial toxicity (Section 7.10). Their sensitivity for predicting coronary stenosis ranges from 85%-90%. An important link in the STEMI Chain of Survival is improving myocardial perfusion by: Either B or C: Blockage of an artery in the brain B) Pulseless electrical activity True Rupture of an artery in the brain. 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