We do not recommend upstream use of either bivalirudin or fondaparinux, although these agents may be utilized in the catheterization lab if warranted. A single copy of these materials may be reprinted for noncommercial personal use only. 10 minutes vol. Transcutaneous pacing is recommended for asystolic individuals who fail to respond to pharmacological interventions. B) Endotracheal tube (ET tube) other interventions. Undertreatment of high risk individuals is also a concern. FALSE One type of acute coronary syndrome is STEMI. In 1822, the society established on the west coast of Africa a colony that in 1847 became the independent nation of Liberia. A) IV or IO access for atropine administration This is especially critical when an emergency department is served by multiple cardiologists/cardiology groups. Which wave represents repolarization of the ventricles? True A) Do not use an AED in water. Emerging evidence suggests that high-sensitivity troponins will be detectable quite early in the setting of NSTEMI. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. True Why should therapeutic hypothermia be considered in an adult Abstract. False C) IV or IO access for epinephrine administration QRS complex Rupture of an artery in the brain. How should the results be interpreted? Improvement in pain with the administration of the classic GI cocktail is not a reliable indicator that ACS is absent. Drugs in this class block thrombin without native antithrombin as a substrate. rhythm? ST segment elevation myocardial infarction (STEMI) refers to complete or near complete occlusion of an epicardial coronary artery, generally due to atherosclerotic plaque rupture and resultant thrombosis. Defibrillators have two different designs for delivering energy. airway (OPA) should only be used on an unconscious individual. Physical examination tips to guide management, C. Laboratory tests to monitor response to, and adjustments in, management, E. Common pitfalls and side-effects of management, A. Therapeutic hypothermia should be considered in the comatose adult after cardiac arrest. The correct option is b) transcutaneous pacing . Definitions The term acute coronary syndrome (ACS) is applied to patients in whom there is a suspicion or confirmation of myocardial injury. Aspirin Their sensitivity for predicting coronary stenosis ranges from 85%-90%. For persistent VF/pulseless VT, vasopressors that may be given during CPR include: The IV route is preferred for drug administration. semi-conscious or conscious individual, while an oropharyngeal According to the 2015 AHA update, high-quality CPR is defined as: 80 chest compressions per minute at a depth of at least one inch, *100-120 chest compressions per minute at a depth of at least two inches, but not greater than 2.4 inches, 100 chest compressions per minute at a depth of at least one inch, 80 chest compressions per minute at a depth of at least two inches. Asystole D) Sinus tachycardia should always be treated with shock therapy. C) Effective CPR WE HAVE A TOTAL OF: Heparin is a polysaccharide that catalyzes and enhances native antithrombin activity, which then inhibits a number of components in the coagulation cascade. A) 50 beats per minute Evidence suggests that PCI can be performed safely with LMWH, without a transition to UFH. D) All heart tissue immediately dies when an individual enters asystole. The ACLS Survey includes assessing which of the following? A) Atrioventricular block 1. CT angiography has emerged as the diagnostic test of choice for suspected pulmonary embolism (PE) with either a high clinical suspicion or elevated d-dimer testing. but constant heart rate between 80 and What is caused by an accumulation of blood in the pericardial A) Give two breaths every 8 to 9 seconds, or 13 to 15 breaths per minute. Conflicting studies have advocated for troponin-only strategies vs. multimarker panels, and various timing regimens (repeat draws at 2,3,4,6, or 8 hours) have been described. interventions. All of the following are found within the 8 D's of Stroke Care EXCEPT: Medication is the only treatment for an unstable tachycardic individual. D. Both B and C, Individuals experiencing a suspected ACS should be transported to: True or False: Medication is the only treatment for an unstable tachycardic individual. 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? Food components may affect digestion and cause functional abdominal disorders of the IBS spectrum . OP-3: median time to transfer to another facility for acute coronary intervention:This metric reports the door-in to door-out time for patients transferred for primary PCI for STEMI or new LBBB. A) To protect the brain/organs True vessel. Herein, we report a method to estimate the thermodynamic potentials of electrochemical reactions at different temperatures. True Acute Coronary Syndrome: What every physician needs to know. False All of the following statements regarding asystole are correct PR segment depression on the ECG is also a specific but insensitive marker for pericardial involvement. A)Oropharyngeal airway (OPA) Circulation. B) They account for 87% of all strokes and are usually caused by an occlusion of an artery to a region of the brain. to a facility that performs PCI because if the MI is due to B) Leave medication patches in place and place the AED electrode pads directly over the patch. a pathologic event. Risk assessment is not a single procedure, but rather an ongoing process that requires an intensive initial evaluation and serial measurements of ECGs and cardiac biomarkers. instability cardioversion should not be delayed . PA and lateral imaging provides more detail and may be preferred if the patient is hemodynamically stable; otherwise, a portable AP chest x-ray should be obtained. A. Synchronized shock with an AED C) Endotracheal tube (ET tube) D) Laryngeal mask airway (LMA), The compression-to-ventilation ratio during CPR prior to placement of an advanced airway is: Which item is NOT a basic airway skill? viral transport media/medium WHO World Health Organization Definitions. D) Head-tilt-chin-lift maneuver, A) Placement of endotracheal tube (ET tube), Which of the following basic airway adjuncts can be used in a conscious or semiconscious indivudual (with an intact cough and gag reflex)? The 2015 JRC guidelines suggest withholding routine high-concentration oxygen supplementation (8 L/min) in normoxic (SpO 2 > 93%) patients with ACS (weak recommendation, very low-quality evidence), except for patients with previous myocardial infarction, severe chronic obstructive pulmonary disease, respiratory failure, cardiogenic shock, central A) Atrial fibrillation 131 Urine toxicology screening should be considered when substance abuse is suspected as a cause of or contributor to . 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. True The increased sensitivity and accuracy over conventional stress imaging is tempered by the restricted availability of this technology. Unstable angina refers to symptoms that are due to impaired blood flow through the coronary arteries that is inadequate to meet metabolic demands, but not to the degree that actual cell death is occurring. Simultaneously, high risk ACS mimics, such as pulmonary embolism and aortic dissection, must be considered and appropriately ruled out. Treatment initiated in the ED is frequently carried into the inpatient setting, so the physician in the ED does have an opportunity to positively influence the future care of the admitted patient. True or False: A nasopharyngeal airway (NPA) can be used on a True C) Left atrium and right ventricle Airway, What does the PR interval on an ECG reflect? While traditional risk factors are useful for primary care management and prevention, they are less useful in the acute assessment and risk stratification of a patient presenting with symptoms concerning for ACS. Cardiogenic shock may present with pulmonary edema, pallor, diaphoresis, or altered mental status. Amsterdam, EA, Kirk, JD, Bluemke, DA. Defibrillators have two different designs for delivering energy. D) 20 minutes, If bradycardia is symptomatic, what is the most likely heart rate exhibited? - Drug Monographs True or False: The definition of stable tachycardia is a fast 2020; doi:10.3390/jcm9113474. B. ECG stress without imaging is insufficient to rule out ACS in a patient presenting emergently with potential symptoms of angina. It is a medical emergency that requires prompt diagnosis and care. C) Analyze rhythm. Accessed Feb. 20, 2019. D) A facility with trauma care, INCORRECT: A) An appropriate center for triage. Patients with a low risk for ACS, as characterized by a low risk stratification score, but not clearly non-cardiac chest pain, should undergo an accelerated diagnostic protocol in an observation setting, including serial evaluations such as biomarkers and ECG. Individuals experiencing a suspected ACS should be transported to: An appropriate center for triage A center that has a dedicated stroke team A facility with trauma care A facility that performs PCI In a bradycardic individual who is symptomatic and does not respond to atropine, the next treatment to consider is: Analgesics Transcutaneous pacing insufficient blood flow to heart muscle) and ranging from unstable angina pectoris to myocardial infarction [ 1 ]. Which of the following is the primary treatment in management C) Conduction through the AV node May consider early conservative strategy and diagnostic protocol. ACLS cardiac arrest algorithm. Which of the following is/are correct regarding False Physical signs are rarely helpful in the diagnosis of ACS. True or False: One type of acute coronary syndrome is What do you suspect is the most likely diagnosis? LUNG DISEASE in individuals with sickle hemoglobin is responsible for significant morbidity and mortality. This is an example of what type of heart B) SA node ACS has received a report from the New York State Central Register (SCR) of Child Abuse and Maltreatment that a child in your care is alleged to have been abused or neglected. bradycardia, it is doubtful that the individual will respond to any Which of the following is correct regarding individuals with acute stroke? False C) Dizziness or loss of balance or coordination Antiarrhythmic drugs to consider for persistent VF/pulseless VT include all of the following EXCEPT: