15961221
Description
Flashcards by Amelia Tuffley, updated more than 1 year ago
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Created by Amelia Tuffley
about 6 years ago
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| Question | Answer |
| Modifiable risk factors for ACS | Dyslipidaemia Hypertension Smoking Diabetes Obesity Sedentary lifestyle Poor diet |
| Non-modifiable risk factors for ACS | Infection Family history Age Gender Ethnicity Socioeconomic status |
| Features of cardiac chest pain | Crushing, gripping, squeezing Radiates to arm(s), jaw, neck, shoulders and hands Unchanged by swallowing, coughing, deep breathing or posturing |
| Conditions in ACS | Angina Unstable angina MI - STEMI or non-STEMI |
| Stable angina defintion | Short lives myocardial ischaemia without infarction which is precipitated by exertion Lasts 3-5 mins, relief with nitrates |
| Unstable angina defintion | Ischaemia without infarction without an obvious precipitating factor Resolves within 20 mins Plaque has become complicated, transient episode of thrombotic vessel occlusion |
| Myocardial infarction definition | Prolonged ischaemia with necrosis of cells >20 mins |
| MI pathophysiology 8-10 seconds | Myocardial oxygen reserves are depleted Glycogen stores decrease as anaerobic metabolism begins Hydrogen ions begin to accumulate Acidosis leaves the myocardium vulnerable |
| MI pathophysiology 10-60 seconds | Oxygen deprivation is accompanied by electrolyte disturbances Failure of ion pumps Release of catecholamines and angiotensin II |
| MI pathophysiology 20 minutes or more | Cell death Release of intracellular contents including cardiac enzymes and proteins |
| ECG changes with STEMI | Hyperacute T waves Biphasic T waves T wave inversion ST depression ST elevation Pathological Q waves |
| CPAP benefits | Decreases preload Opens alveoli Reduces work of breathing Improves oxygenation |
| Indications for Primary Percutaneous Coronary Intervention (PCI) | < 60 min transport to nearest PCI capable hospital GCS 15 Classic ongoing cardiac chest pain (not atypical) 12 lead ECG with ST elevation >1mm in contiguous limb leads or >2mm in chest leads Normal QRS width or RBBB **ACUTE MI SUSPECTED** on Lifepak |
| Primary Percutaneous Coronary Intervention (PCI) steps | 1. Request CCP back up code 1 (for an STEMI) 2. Confirm the patient is indicated for decision 3. Complete the checklist 4. Obtain information consent from the patient 5. Contact the referral line 6. Administer Heparin and Ticagrelor (following cardiologist instructions) 7. Transport code 1 to hospital |
| Heparin mechanism of action | Activates antithrombin III Prevents clots from forming |
| Heparin contraindications | • KSAR • < 18 years • Active bleeding or clotting disorder • Prior intracranial haemorrhage •Current use of anticoagulants eg warfarin NOT aspirin |
| Ticagrelor mechanism of action | Direct P2Y12 receptor antagonist Prevents ADP induced platelet aggregation Prevents expression of GPIIb and Iia |
| Ticagrelor contraindications | • KSAR • < 18 years • Patient currently taking ticagrelor or clopidogrel • Cardiologist may tell you to give them a “top-up” dose (need to record this) • Active bleeding or clotting disorder • Prior intracranial haemorrhage • History of hepatic impairment |
| Thrombolysis, steps Used out bush | 1. Request CCP backup code 1 (all STEMIs) 2. Confirm the patient is indicated for decision supported thrombolysis 3. Complete the checklist 4. Send a photograph of the 12 lead ECG to consult line email address • Don’t need to wait for replywhen you call later they should all be able to access it on their screen 5. Contact QAS consult like 6. Obtain informed consent from the patient 7. Administer clexane (loading dose, IV), tenectoplase, clopidogrel and clexane (subcut) 8. Transport code 2 to hospital |
| List the thrombolytic drugs | Clexane/enoxaparin Clopidogrel Tenecteplase |
| Clexane/enoxaparin MOA | • One of the components of Heparin • Only affects 1 point in the clotting cascade • Antithrombin III enhancer • Only works on Xa due to small size of the molecule • 30mg IV as loading dose then 1mg/Kg subcut maintenance dose 15 minutes after loading |
| Clopidogrel MOA | • Active metabolite so requires metabolism to activate drug (enzyme CYP2C19) -> oral tablet • Small % of people don’t express this enzyme highly or at all and so will not be effective • P2Y12 receptor antagonist • Prevents ADP induced platelet aggregation • Prevents expression of GP IIb and Iia |
| Tenecteplase MOA | • Binds with fibrin component of the thrombus • Converts plasminogen to plasmin • Uses bodies natural process for removing clots • Weight based dose, push over 10 seconds • Drug is a powder -> mix with water gently or it will froth and you only have one in the kit! • Can cause arrhythmias but you can shock them out of it -> have pads on |
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