NSER 7210 - Module 3 Exam -56 Q’s and A’s
Apply a systematic approach to patients with chest pain and acute coronary syndromes - -
C - Check pulse = CPR, Crash cart with pads
A - AVPU, Airway Patent, suction, airways
B - WOB, SOB, O2 sat - O2 if <90%
C - ED handshake, skin, IV, Tele, ECG
D - Doctor - this patient is unstable
E - Pacemaker? Hx of cardic surgery?
-Describe an aortic dissection, and describe the typical signs/symptoms - -A tear in the
intimal layer of the thoracic or abdominal aortic wall
Chest pain maximal at onset, described as "tearing or ripping", radiates to the back.
Accompanied by neurological or pulse deficit. and/or BP differential >20mmHg between
extremities.
-Describe a PE, and describe the typical signs/symptoms - -Thrombus within pulmonary
circulation
Pleuritic chest pain, fatigue, dyspnea, syncope, hemoptysis, tachycardia, cardiac arrest
-Describe the typical signs/symptoms of an esophageal rupture - -Vomiting followed by
severe chest pain, SOB and subcu emphysema, and rapid circulatory collapse
-Describe the typical signs/symptoms of a pneumothorax - -Pain (Sudden and pleuritic)
and SOB, absence of breath sounds
Tension pneumo - deviated trachea way from collapsed lung
-Describe the typical signs/symptoms of acute pericarditis - -Chest pain that may radiate
to the back, neck or shoulders that is worse with inspiration, improved while sitting up or
leaning forward
Dyspnea
ECG changes: concave ST segment elevation, T wave inversions or PR segment depression
that are present in many leads (not contiguous leads)
-Describe stable angina - -AKA demand ischemia. Chest pain triggered by stress or
exertion. Resolves with rest +/- nitro.
No ECG or biomarker changes, no injury to heart tissue
-Describe unstable angina - -Blood flow through a coronary artery is partially or
intermittently blocked.
Symptoms: Symptoms occur and linger at rest
Myocardial ischemia occurs, but no injury.
ECG may show T-wave inversion or ST depression
No change in biomarkers
, -Describe an NSTEMI - -Blockage of a coronary artery with collateral circulation in tact, or
a blockage in microcirculation.
Symptoms occur at rest
ECG may show T-wave inversion or ST depression
Biomarkers elevated as tissue injury occurs
-Describe a STEMI - -Complete blockage of a coronary artery causing tissue ischemia and
injury, if not resolved = cell death
ECG - ST segment elevated in at least 2 contiguous leads
Biomarkers elevated
-Describe the 2 reperfusion strategies for coronary artery blockage - -1. PCI -
Percutaneous coronary intervention - A catheter is used to open the blocked or narrowed
artery
2. Fibrinolytics - Converts plasminogen to plasmin which breaks down fibrinogen and
fibrin clots
-State the coronary artery involved in an Septal MI - -LAD
Leads: V1 and 2
-State the coronary artery involved in an Anterior MI - -LAD
Leads: V3 and 4
-State the coronary artery involved in a lateral MI - -Circumflex
Leads: V5, 6, I and aVL
-State the coronary artery involved in an inferior MI - -RCA or Circumflex
Leads: II, III, aVF
-When is a 15 lead ECG indicated? - -A patient presents with possible ACS and ECG
changes of ST depression in leads V1-4.
-State the goal for Door to diagnosis in a STEMI - -<10mins
-State the goal for Door to Balloon in a STEMI at a PCI center - -<90mins
-State the goal for Door to Fibrinolysis in a STEMI at a non-PCI center - -<30mins
*only for hospitals more than 60mins away from a PCI center
-State the goal for Door to Balloon in a STEMI at a non-PCI center - -<120mins
*Only if a PCI center is within 60min transport time
-Outline what classifies a "Successful Thrombolysis" and what to do after treatment - -
Relief of chest pain, regression of ST segment elevation, reperfusion arrhythmias
If failed: Immediate transfer to a PCI site
If successful: Routine PCI within 24hours
Apply a systematic approach to patients with chest pain and acute coronary syndromes - -
C - Check pulse = CPR, Crash cart with pads
A - AVPU, Airway Patent, suction, airways
B - WOB, SOB, O2 sat - O2 if <90%
C - ED handshake, skin, IV, Tele, ECG
D - Doctor - this patient is unstable
E - Pacemaker? Hx of cardic surgery?
-Describe an aortic dissection, and describe the typical signs/symptoms - -A tear in the
intimal layer of the thoracic or abdominal aortic wall
Chest pain maximal at onset, described as "tearing or ripping", radiates to the back.
Accompanied by neurological or pulse deficit. and/or BP differential >20mmHg between
extremities.
-Describe a PE, and describe the typical signs/symptoms - -Thrombus within pulmonary
circulation
Pleuritic chest pain, fatigue, dyspnea, syncope, hemoptysis, tachycardia, cardiac arrest
-Describe the typical signs/symptoms of an esophageal rupture - -Vomiting followed by
severe chest pain, SOB and subcu emphysema, and rapid circulatory collapse
-Describe the typical signs/symptoms of a pneumothorax - -Pain (Sudden and pleuritic)
and SOB, absence of breath sounds
Tension pneumo - deviated trachea way from collapsed lung
-Describe the typical signs/symptoms of acute pericarditis - -Chest pain that may radiate
to the back, neck or shoulders that is worse with inspiration, improved while sitting up or
leaning forward
Dyspnea
ECG changes: concave ST segment elevation, T wave inversions or PR segment depression
that are present in many leads (not contiguous leads)
-Describe stable angina - -AKA demand ischemia. Chest pain triggered by stress or
exertion. Resolves with rest +/- nitro.
No ECG or biomarker changes, no injury to heart tissue
-Describe unstable angina - -Blood flow through a coronary artery is partially or
intermittently blocked.
Symptoms: Symptoms occur and linger at rest
Myocardial ischemia occurs, but no injury.
ECG may show T-wave inversion or ST depression
No change in biomarkers
, -Describe an NSTEMI - -Blockage of a coronary artery with collateral circulation in tact, or
a blockage in microcirculation.
Symptoms occur at rest
ECG may show T-wave inversion or ST depression
Biomarkers elevated as tissue injury occurs
-Describe a STEMI - -Complete blockage of a coronary artery causing tissue ischemia and
injury, if not resolved = cell death
ECG - ST segment elevated in at least 2 contiguous leads
Biomarkers elevated
-Describe the 2 reperfusion strategies for coronary artery blockage - -1. PCI -
Percutaneous coronary intervention - A catheter is used to open the blocked or narrowed
artery
2. Fibrinolytics - Converts plasminogen to plasmin which breaks down fibrinogen and
fibrin clots
-State the coronary artery involved in an Septal MI - -LAD
Leads: V1 and 2
-State the coronary artery involved in an Anterior MI - -LAD
Leads: V3 and 4
-State the coronary artery involved in a lateral MI - -Circumflex
Leads: V5, 6, I and aVL
-State the coronary artery involved in an inferior MI - -RCA or Circumflex
Leads: II, III, aVF
-When is a 15 lead ECG indicated? - -A patient presents with possible ACS and ECG
changes of ST depression in leads V1-4.
-State the goal for Door to diagnosis in a STEMI - -<10mins
-State the goal for Door to Balloon in a STEMI at a PCI center - -<90mins
-State the goal for Door to Fibrinolysis in a STEMI at a non-PCI center - -<30mins
*only for hospitals more than 60mins away from a PCI center
-State the goal for Door to Balloon in a STEMI at a non-PCI center - -<120mins
*Only if a PCI center is within 60min transport time
-Outline what classifies a "Successful Thrombolysis" and what to do after treatment - -
Relief of chest pain, regression of ST segment elevation, reperfusion arrhythmias
If failed: Immediate transfer to a PCI site
If successful: Routine PCI within 24hours
