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Acute Coronary Syndromes Practice Test

A 12-lead ECG should be obtained and analyzed within____minutes of the patient's arrival in the ED (emergency department). 10 20 30 60 ED personnel should review the out-of-hospital 12-lead ECG if available. If not performed, acquisition of the 12-lead ECG should be a priority. The goal is to analyze the 12-lead ECG as soon as possible within 10 minutes of the patient's arrival in the ED. AHA Advanced Cardiovascular Life Support Provider Manual, p. 67 The most common symptom of ischemia and/or myocardial infarction is: Arm, neck or jaw pain Chest pain behind the sternum (retrosternal chest pain) Pain between the shoulder blades Sudden shortness of breath not explained by other reasons All of these are symptoms of myocardial ischemia and infarction. The most common symptom of myocardial ischemia and infarction is retrosternal chest discomfort. The patient may perceive this discomfort more as pressure or tightness than actual pain. AHA Advanced Cardiovascular Life Support Provider Manual, p. 63 Which of the following patients would you avoid giving aspirin to? A patient who is being treated for peptic ulcer disease A patient with a history of diverticular disease A patient with a history of gallbladder disease A patient that has recently undergone a colonoscopy In the initial hours of an ACS, aspirin is absorbed better when chewed than when swallowed. Use rectal aspirin suppositories for patients with nausea, vomiting, active peptic ulcer disease, or other disorders of the upper GI tract. AHA Advanced Cardiovascular Life Support Provider Manual, p. 65 Which of the following patients would you avoid administering nitroglycerin to? A patient with a heart rate of 60 beats per minute A patient that admits to taking Viagra (sildenafil nitrate) in the last 12 hours A patient with a systolic blood pressure of 98mm Hg A patient experiencing an anterolateral infarction Avoid the use of nitroglycerin if it is suspected or known that the patient has taken sildenafil or vardenafil within the previous 24 hours or tadalafil within 48 hours. These agents are generally used for erectile dysfunction or in cases of pulmonary hypertension and in combination with nitrates may cause sever hypotension refractory to vasopressor agents. AHA Advanced Cardiovascular Life Support Provider Manual, p. 65 Morphine is given in ACS because: It reverses the effects of catecholamine release on the body, and lowers myocardial oxygen demand It acts as a venodilator, reducing oxygen requirements and left ventricular preload Assists in redistributing blood flow in patients with acute pulmonary edema All of the above AHA Advanced Cardiovascular Life Support Provider Manual, p. 66 Which intervention is at the center of the decision pathway in the management of ischemic chest pain, according to the ACS Algorithm? Fibrinolytic checklist Initial cardiac marker levels Targeted history 12-lead ECG (ECG interpretation) The 12-lead ECG analysis is the decision pathway in the ACS algorithm. It is used to identify STEMI, NSTE-ACS, or low/intermediate-risk ACS, which then determines treatment. AHA Advanced Cardiovascular Life Support Provider Manual, p. 67 For a patient with STEMI, goals of reperfusion include giving fibrinolytics or performing PCI (percutaneous coronary intervention) within a certain timeframe of the patient's arrival in the ED. What are these time parameters? Fibrinolytics within 15 minutes, PCI within 30 minutes Fibrinolytics within 90 minutes, PCI within 30 minutes Fibrinolytics within 20 minutes, PCI within 60 minutes Fibrinolytics within 30 minutes, PCI within 90 minutes Goals of reperfusion for patients with STEMI are to administer fibrinolytic within 30 minutes (door-to-needle) or perform PCI within 90 minutes (door-to-balloon inflation). AHA Advanced Cardiovascular Life Support Provider Manual, p. 67, 70-71 A major contraindication to the administration of both nitroglycerin and morphine is: Hypotension Recent GI bleed Recent CVA Recent phosphodiesterase inhibitor use Hypotension, including hypotension from an RV or right inferior infarction, is the major contraindication to use of both morphine and nitroglycerin. In the presence of RV or right inferior infarction, administering these drugs may result in severe hypotension. Recent GI bleed or hemorrhagic stroke are contraindications to aspirin administration. Phosphodiesterase inhibitor is a contraindication to administration of nitroglycerin, but not to morphine use. AHA Advanced Cardiovascular Life Support Provider Manual, p. 65-66 STEMI is characterized by: ST-segment elevation in 2 or more contiguous leads OR new LBBB Ischemic ST-segment depression greater than or equal to 0.5mm OR dynamic T-wave inversion with pain or discomfort Nondiagnostic changes in the ST segment or T-wave Nonpersistent/transient ST elevation greater than or equal to 0.5mm for less than 20 minutes STEMI is characterized by ST-segment elevation in 2 or more contiguous leads OR new LBBB. AHA Advanced Cardiovascular Life Support Provider Manual, p. 68 - 69 Which of the following drugs is not included as part of ED general treatment for chest pain? Epinephrine Aspirin Morphine Nitroglycerin Morphine, oxygen, nitroglycerin and aspirin are given as part of immediate ED general treatment for patients with ACS. Epinephrine is used to treat a variety of dysrhythmias. AHA Advanced Cardiovascular Life Support Provider Manual, p. 59, 69