QUESTION
what is chest pain
Answer:
most common presentation of ACS (e.g. unstable angina, non-q wave MI, q-wave MI);
described as uncomfortable pressure, fullness, squeezing, pain in center of the chest lasting
several minutes, pain spreading to shoulders/neck/arms/jaw
chest discomfort with lightheadedness. fainting, sweating, nausea, or shortness of breath,
impending doom
QUESTION
chest pain treatment
Answer:
1. o2 at 4 LNC to have spo2 >94%
2. NTG .4 mg SL if SBP >90 or MAP >60 mmHG and HR > 50 BPM. may repeat x2 every 3-5
minutes
3. morphine 2 mg ivp/io q5 min up to total of 10 mg if SBP >90
4. aspirin 325 mg if not contraindicated and no dose given on this date
5. hypotension occurs and no CHF, give 250 NS bolus
6. 12 lead EKG - if ST segment is > 2 mm in 2 leads or has new onset of BBB it is suggestive of
stemi
QUESTION
goal for PCI with MI
Answer:
, PCI or thrombolytics in <90 minutes
QUESTION
symptomatic hypotension
Answer:
SBP <90. clincial signs: clammy skin, cool, oliguria, increased HR, impaired sensorium
if hypotension is associated with arryhthmia, treat the rhythm!
hypotension post anesthesia is tx with fluid replacement and ephedrine
QUESTION
treat symptomatic hypotension
Answer:
1. o2 min 10 L/min NRBM
2. if hypovolemia is suspected infuse 250ml/NS. repeat in 5. can use LR if running.
3. if SBP <90, start dopamine 400 mg/250 at 5 mcg/kg/min. Titrate to max of 20 mcg to achieve
of SBP >90/MAP 60 mmhg.
4. if obvious blood loss draw stat H&H and type and cross for 2 units PRBCs.
5. if sepsis is suspected follow sepsis algorithm.
QUESTION
for PACU patients hypotension
Answer:
1. o2 at 10 L/min NRBM
2. infuse 250 ml NS, repeat in 5 min.
3. if bolus is ineffective administer ephedrine 5 mg ivp/io
4. if no improvement within 3 minutes, repeat at 10 mg ivp/io
5. in presence of blood loss draw stat h/h, type and cross 2 units
QUESTION
what is chest pain
Answer:
most common presentation of ACS (e.g. unstable angina, non-q wave MI, q-wave MI);
described as uncomfortable pressure, fullness, squeezing, pain in center of the chest lasting
several minutes, pain spreading to shoulders/neck/arms/jaw
chest discomfort with lightheadedness. fainting, sweating, nausea, or shortness of breath,
impending doom
QUESTION
chest pain treatment
Answer:
1. o2 at 4 LNC to have spo2 >94%
2. NTG .4 mg SL if SBP >90 or MAP >60 mmHG and HR > 50 BPM. may repeat x2 every 3-5
minutes
3. morphine 2 mg ivp/io q5 min up to total of 10 mg if SBP >90
4. aspirin 325 mg if not contraindicated and no dose given on this date
5. hypotension occurs and no CHF, give 250 NS bolus
6. 12 lead EKG - if ST segment is > 2 mm in 2 leads or has new onset of BBB it is suggestive of
stemi
QUESTION
goal for PCI with MI
Answer:
, PCI or thrombolytics in <90 minutes
QUESTION
symptomatic hypotension
Answer:
SBP <90. clincial signs: clammy skin, cool, oliguria, increased HR, impaired sensorium
if hypotension is associated with arryhthmia, treat the rhythm!
hypotension post anesthesia is tx with fluid replacement and ephedrine
QUESTION
treat symptomatic hypotension
Answer:
1. o2 min 10 L/min NRBM
2. if hypovolemia is suspected infuse 250ml/NS. repeat in 5. can use LR if running.
3. if SBP <90, start dopamine 400 mg/250 at 5 mcg/kg/min. Titrate to max of 20 mcg to achieve
of SBP >90/MAP 60 mmhg.
4. if obvious blood loss draw stat H&H and type and cross for 2 units PRBCs.
5. if sepsis is suspected follow sepsis algorithm.
QUESTION
for PACU patients hypotension
Answer:
1. o2 at 10 L/min NRBM
2. infuse 250 ml NS, repeat in 5 min.
3. if bolus is ineffective administer ephedrine 5 mg ivp/io
4. if no improvement within 3 minutes, repeat at 10 mg ivp/io
5. in presence of blood loss draw stat h/h, type and cross 2 units
QUESTION
