Case 2 - ACS

Question 1

Most patients who die of ACS due to _____ within 4 hours of symptom onset.

A. Asystole
B. pVT/VF
C. VT

Answer 1

B. pVT/VF

Question 2

S/S of cardiac ischemia

Answer 2

• Pressure, fullness, squeezing in center of chest
• radiating chest discomfort to shoulder/neck/arm(s)/jaw/etc.
• dizziness/fainting/sweating/N/V
• shortness of breath +/- chest pain

Question 3

Outline EMS assessment/care of the ACS patient.

Answer 3

• Support and manage ABCs
• Administer MONA (Morphine, Oxygen, NTG, and ASA)
• Complete fibrinolytic checklist if indicated
• Provide pre-notification of STEMI

Question 4

T/F: EMS providers may consider not providing oxygen to the normoxic patient.

Answer 4

True.

Question 5

ASA acts to _____ by inhibiting COX-1.

A. inhibit platelet aggregation
B. Break up coronary clots

Answer 5

A. inhibit platelet aggregation

Question 6

NTG acts to reduce ischemia by ____.

Answer 6

reducing LV/RV preload through dilation of the systemic circulation (both arterial and venous).

Question 7

What are the contraindications for NTG?

Answer 7

• Inferior MI/RV infarction
• HypoTN (SBP under 90), bradycardia (HR under 50), tachycardia
• recent ED drug use

Question 8

Why, specifically, is morphine use judiciously monitored in the ACS patient?

Answer 8

Morphine acts as a venodilator, and can thus reduce preload and SBP

Question 9

What ECG findings are present in NSTE-ACS?

Answer 9

ST depression/dynamic T-wave inversion