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 I...
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 - ANSWER-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
His initial vital signs are HR 120/min, BP 135/88 mm Hg, RR 23/min, SpO2 87%, and temperature
37.3C. When considering oxygen saturation, what is your course of action?
o Intubate the patient immediately
o Administer albuterol nebulizer
o Do not start oxygen
o Start oxygen at 4L/min via nasal cannula - ANSWER-o Start oxygen at 4L/min via nasal cannula
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? - ANSWER-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 - ANSWER-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 - ANSWER-o Anterior ST-segment
elevation of myocardial infarction (STEMI)
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 - ANSWER-o Establish IV access
o Order an emergent CT scan or MRI of the brain and review patient history
o Activate the stroke team
o Complete neurologic screening
o Check glucose
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