endstream endobj 1 0 obj <> endobj 2 0 obj <>stream False What do you suspect is the most likely diagnosis? D) Atrial flutter, During the post-cardiac arrest phase, which of the following medications can be used to treat hypotension? If ACS is suspected, a 12-lead ECG should be obtained prior to patient transport. Fecal calprotectin (FCAL) is used as a marker to distinguish between organic IBD and functional bowel disease in disorders of the irritable bowel syndrome (IBS) spectrum. The compression-to-ventilation ratio during CPR prior to placement of an advanced airway is: The proper steps for operating an AED are: Power on the AED, analyze the rhythm, attach electrode pads, and shock the individual. Likewise, severe infection may cause metabolic demands that exceed myocardial capacity, resulting in myocardial necrosis (elevated troponin) that is not due to true ACS/coronary plaque rupture. The following drugs and/or interventions may be used in the ACS individual for cardiac reperfusion: C. Percutaneous coronary intervention (PCI). C) 70 beats per minute Hyperventillation (over ventillation) can be harmful because it: What reason is NOT valid during the critical early defibrillation for individuals experiencing sudden cardiac arrest? It is the authors preference that, in the absence of substantial hypertension with tachycardia, one should refrain from administering upstream beta blockers. B) Sinus tachycardia is a normal rhythm and never considered dangerous. A) Maintain blood pressure. A) Lidocaine other interventions. Chest pain is a common complaint in patients at primary care offices, emergency departments, and inpatient medical services. Cardiac tamponade Which of the following would be appropriate actions following transcutaneous pacing? That is, high risk patients should still receive aggressive pharmacologic therapy. Current troponin assays in clinical use are substantially more sensitive than previous iterations, and are detectable in the first few hours after infarction. The care of patients transferred to another hospital for inpatient care must meet the standards set by the Hospital-Outpatient metrics, discussed below. unfractionated heparin may be preferred over low molecular weight heparin, intravenous contrast exposure should be limited where possible, and isosmolar agents are preferred, renally cleared drugs should be dose adjusted, patients with diabetes should receive an ACE inhibitor (or ARB if ACE is not tolerated) if not contraindicated due to renal insufficiency, glycemic control should be maintained during hospitalization. Patients with suspected ACS should be risk stratified based on the likelihood of ACS and adverse outcome(s) to decide on the . A) 50 beats per minute The exception to this is suspected acute aortic dissection as the etiology for the patients STEMI. asystole? management? - Conference Coverage Altered mental status, headache, and vomiting may indicate an intracranial hemorrhage. Individuals experiencing a suspected ACS should be transported Fluid boluses should be utilized to support preload. B) Administer oxygen. D) Suctioning, What item is NOT an example of Advanced Airways? Patients with high risk features or at high risk for adverse outcomes per risk stratification score should receive aggressive medical management (at least dual antiplatelet therapy and anticoagulation), admission to an inpatient unit, and cardiac catheterization with the intent to perform PCI, preferably within 24 hours of presentation. Tachycardia is defined as a heart rate greater than: Signs of unstable tachycardia may include all of the following EXCEPT: Critical in-hospital goals of stroke care include a neurological assessment by the stroke team and a CT scan performed within ________ of hospital arrival. C) CPR until pulse is detectable In a suspected acute stroke individual, you must always immediately obtain IV access. In the case of continued angina and hypertension when beta-blockers are contraindicated, a non-dihydropyridine calcium channel blocker, such as verapamil or diltiazem, can be considered. A) Left atrium If the AED advises no shock, you should still defibrillate because defibrillation often restarts the heart with no pulse. After arrival of an acute stroke individual in the ED, in what Basic airway skills include all of the following EXCEPT: Which type of suction catheter provides the most effective suctioning of the oropharynx and thick particulate matter? sal-ns-acls Cardiac troponin (either I or T) is preferred for the initial diagnosis of ACS due to its superior sensitivity and specificity. For persistent VF/pulseless VT, vasopressors that may be given during CPR include: Antiarrhythmic drugs to consider for persistent VF/pulseless VT include all of the following EXCEPT: The order of priority for routes of access for drugs is: The IV route is preferred for drug administration. A) 60 minutes B) Advanced airway insertion AMI 1: aspirin at arrival: This measure applies to both non-STEMI and STEMI. What are they? This class of intravenous medications includes abciximab, eptifibatide, and tirofiban, and acts to impair platelet aggregation by competitive antagonism at the surface glycoprotein IIb/IIIa (GP IIb/IIIa) receptor. A) 10 minutes True or False: Medication is the only treatment for an unstable tachycardic individual. Angiotensin converting enzyme (ACE) inhibitors have multiple beneficial effects in patients with structural heart disease and impaired systolic function. FALSE One type of acute coronary syndrome is STEMI. D) Wide or narrow, After arrival of an acute stroke individual in the ED, in what time frame should an assessment and an order for a CT scan be completed? The use of these medications requires balancing the preservation of coronary artery blood flow with the increased risk of bleeding associated with them. C) 90 minutes CORRECT: Which of the following can represent a correct treatment choice for an individual in asystole? True or False: The definition of stable tachycardia is a fast but constant heart rate between 80 and 120 beats per minute. D) Magnesium, Bradycardia is defined as any rhythm disorder with a heart rate less than: https://www.merckmanuals.com/professional/cardiovascular-disorders/coronary-artery-disease/overview-of-acute-coronary-syndromes-acs. Natriuretic peptide testing may be considered, as elevated BNP is linked to a poor long term outcome in ACS. There are no biomarkers that have been validated for the detection of cardiac ischemia as opposed to infarction. CMG 2 pain management; CMG 9 respiratory distress, etc.). Multiple comorbidities may affect how ACS is managed, depending on the severity of the comorbidity. This metric reports the interval from patient arrival at the ED to ECG acquisition. If the patient was transferred from another hospital, designated as comfort care only, or if there are explicitly documented reasons for a delay (cardiac arrest, patient refusal, diagnostic uncertainty regarding the STEMI), the measure will also not apply. Which of the following can be a result of prolonged asystole? rd degree AV blocks, hemifascicular blocks) or profound bradycardia. Physical examination findings that would be suggestive of deterioration include: While on anticoagulation, the physician should monitor for signs of bleeding, including: Serial cardiac biomarkers should be monitored until at least 6 hours after the onset of symptoms to detect the typical rise associated with myocardial infarction. However, the use of beta blockers early in the management of ACS has been de-emphasized in recent years subsequent to the COMMIT trial, which studied intravenous metoprolol in the setting of AMI. Any bradycardia less than 60 beats per minute is a pathologic event. A) After three "No Shock Advised" messages are receivedB) After one shock has been delivered and the patient remains in cardiac arrestC) Before delivering the first shock when a "Shock Advised" message is receivedD) Immediately upon determining that the patient is in cardiac arrest A A) After three "No Shock Advised" messages are received 8 Q Unfortunately, the optimum timing for laboratory draws or selection of biomarkers has not been defined. 54. AMI 8a: primary PCI received within 90 minutes of arrival: The proportion of patients as defined above who receive primary PCI within 90 minutes of arrival to the ED. interventions. D) They account for 13% of all strokes and are caused by an occlusion of an artery to a region of the brain. Acute coronary syndromes are divided into three categories. Cardiogenic shock may present with pulmonary edema, pallor, diaphoresis, or altered mental status. Supplemental oxygen should never be given to an individual with acute stroke . Research is ongoing in order to delineate the precise role of cardiac MRI in the risk stratification process. 2205-41. Right or left Twins are generally regarded as obstacles to dislocations in face-centered cubic metals and can modify individual dislocations by locking them in twin boundaries or obliging them to dissociate. D) Sinus tachycardia should always be treated with shock therapy. Early access to medical care, from EMS through reperfusion, improves overall outcomes by: Transcutaneous pacing should be used on an individual with bradycardia and inadequate perfusion if atropine is ineffective and the individual is exhibiting severe symptoms. C. The individual becomes pulseless B) A center that has a dedicated stroke team CMG 16 - SUSPECTED ACUTE CORONARY SYNDROM E Having to adjust medication regimens based on which cardiologist is on call, instead of patient-based characteristics, is a recipe for error. Women will need to lift their breasts to check the skin underneath. D) Debilitation, Where is the start of the mechanical movement of the heart generally thought to begin? C) Jaw-thrust maneuver without head extension with acute stroke ? Ischemic stroke is caused by the occlusion of an artery. sal-ns-acls. AMI 8: median time to primary PCI:This measure applies to patients with STEMI or new left bundle branch block (LBBB) on the initial ECG that receive PCI as the primary treatment. Objective This article will discuss the role of troponin testing in the diagnosis of ACS, and the role of high-sensitive troponin, which is now in widespread use. Individuals experiencing a suspected ACS should be transported to: A facility with trauma care A facility that performs PCI An appropriate center for triage A center that has a dedicated stroke team 5. An individual should be cleared- prior to a shock only when convenient. Heparin-based products may induce an immune reaction causing sensitization to platelets (heparin induced thrombocytopenia, or HIT). Most alkyl bromides are water-insoluble liquids. Defibrillators have two different designs for delivering energy. This is the percentage of ED patients over the age of 40 with a diagnosis that includes non-traumatic chest pain who received a 12-lead ECG. ACLS cardiac arrest algorithm. Contact A contact is defined as any individual who has: spent any length of time in a room or enclosed space with a confirmed measles case during that case's infectious period (i.e. The increased sensitivity and accuracy over conventional stress imaging is tempered by the restricted availability of this technology. True PR segment depression on the ECG is also a specific but insensitive marker for pericardial involvement. In a suspected acute stroke individual, you must always immediately obtain IV access. B) SA node Why should therapeutic hypothermia be considered in an adult comatose person during the post-cardiac arrest period? Citations for the most recent recommendations are below: Anderson, JL, Adams, CD, Antman, EM. These measures DO NOT APPLY if the patient is admitted from the ED to the inpatient setting without a transfer. 60 minutes A pericardial friction rub will be pathognomonic, but can be transient and not present during assessment. False When evaluating the patient without STEMI, chest radiography should be obtained to explore alternate diagnoses (aortic dissection, pneumothorax, pneumonia, rib fractures) or comorbidities (cardiomegaly, pulmonary edema). - Drug Monographs Serial hemoglobin measurements should be obtained if occult blood loss is suspected. A) An appropriate center for triage The anticoagulation effect of UFH is less predictable, requiring frequent PTT monitoring and infusion rate adjustment. Accessed Feb. 20, 2019. The correct option is b) transcutaneous pacing . Ischemic stroke is caused by the occlusion of an artery. 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