Within the first 10 minutes, on the basis of the patient showing symptoms suggestive of myocardial ischemia, what will your first actions
include (if not completed by EMS before arrival)?
o Obtain a 12-lead electrocardiogram (ECG)
o Administer a blood thinner
o Administer aspirin and establish IV access
o Activate the ST-segment elevation myocardial infarction (STEMI) team
o If SPO2 is less than 90%, start oxygen
o Assess airway, breathing, and circulation (ABCs)
o Administer epinephrine 1 mg IV
o Consider nitroglycerin, morphine and a P2Y inhibitor ✔️o Obtain a 12-lead electrocardiogram (ECG)
o Administer aspirin and establish IV access
o Activate the ST-segment elevation myocardial infarction (STEMI) team
o If SPO2 is less than 90%, start oxygen
o Assess airway, breathing, and circulation (ABCs)
o Consider nitroglycerin, morphine and a P2Y inhibitor
Notify receiving hospital
Review Fibrinolytic checklist
What additional question help you determine next steps?
o Do you take any medication?
o Do you have any allergies?
o When was the last time you went to the doctor?
o When did the symptoms start?
o Have you had any recent falls? ✔️o Do you take any medication?
o Do you have any allergies?
o When did the symptoms start?
Your patient continues to say that he has chest discomfort. What treatment can you repeat as long as it is not contradicted by vital signs?
o Morphine sublingual every 1 to 3 minutes
o Morphine IV every 1 to 3 minutes
o Nitroglycerine sublingual or translingual every 3 to 5 minutes
o Nitroglycerine every 1 to 3 minutes ✔️o Nitroglycerine sublingual or translingual every 3 to 5 minutes
What is your interpretation of the patient's ECG tracing?
o Anterior ST-segment elevation of myocardial infarction (STEMI)
o Ventricular tachycardia
o Posterior ST-segment elevation myocardial infarction (STEMI)
, o Normal sinus rhythm with premature ventricular contractions ✔️o Anterior ST-segment elevation of myocardial infarction (STEMI)
With the diagnosis of STEMI, what is the most probable treatment?
o Release to home
o Admission to an intensive car unit
o Admission for observation
o Admission for PCI or fibrinolysis ✔️o Admission for PCI or fibrinolysis
What is your goal for PCI when treating this patient?
o Door-to-balloon inflation time of 30 minutes
o First medical contact-to-balloon inflation time of 90 minutes
o Door-to-needle time of 90 minutes
o First medical contact-to-needle time of 30 minutes ✔️o First medical contact-to-balloon inflation time of 90 minutes
The patient's vital signs show HR 92/min, RR 14/min, BP 130/86 mm Hg, SpO2 97%, and atrial fibrillation on the monitor. What additional
assessment and stabilization activities should be completed with the first 10 minutes after the patient's arrival?
o Establish IV access
o Order an emergent CT scan or MRI of the brain and review patient history
o Monitor for worsening symptoms
o Activate the stroke team
o Complete neurologic screening
o Check glucose
o Administer O2 ✔️Perform validated pre-Hospital stroke screen and stroke severity tool
o initiate stroke protocol
o established time of symptom onset (last known normal)
o provide pre-hospital notification to the receiving hospital
o Check glucose
What needs to be completed for this patient within 20 minutes after hospital arrival?
o Neurologic assessment
o Admission to a monitored bed
o Interpretation of the emergent CT scan or MRI of the brain
o Administration of fibrinolytic therapy ✔️o Neurologic assessment
As part of the neurologic assessment, you perform a physical and neurologic examination. What are some of the general questions you need to
ask?
o What other symptoms do you have?
o Has your wife been sick as well?
o Do you take any medications?
o Did you eat anything today?