Mod-4 Acute Coronary Syndromes Part 2 12 LEAD

Download
Share  Add to  Flag Embed
Views:
 
Category: Education
     
 
License:   All Rights Reserved

Presentation Description

No description available.

Comments

Presentation Transcript

Slide 1:

Acute Coronary Syndromes Part 2 MODULE 4

Goals for Module 4:

Goals for Module 4 Rapidly identify and treat patients eligible for acute reperfusion therapy

Acute Reperfusion Therapy:

Acute Reperfusion Therapy Thrombolytics Retaplase (rPA) Actiplase (tPA) Streptokinase Percutaneous Transluminal Coronary Angioplasty (PTCA) Balloon Stent Atherectomy

Acute Reperfusion Therapy:

Acute Reperfusion Therapy

The 12-Lead ECG:

The 12-Lead ECG ST elevation - the key to the acute reperfusion therapy subset You can’t see ST elevation without a 12-lead ECG

The 12-Lead ECG:

The 12-Lead ECG Perform on every patient suspected of ACS Obtain early with the first vital signs Repeat frequently every 5-10 minutes each change of symptoms

The 12-Lead ECG:

The 12-Lead ECG The three ECG subsets Nondiagnostic: no ST or T wave abnormalities Suspicious for ischemia: ST depression or T wave inversion Suspicious for injury: ST elevation

The 12-Lead ECG:

The 12-Lead ECG Nondiagnostic: no ST or T wave abnormalities Does NOT rule out MI or other acute coronary syndromes Not a candidate for acute reperfusion therapy

Non-Diagnostic ECG:

Non-Diagnostic ECG

The 12-Lead ECG:

The 12-Lead ECG Suspicious for ischemia: ST depression or T wave inversion Does NOT rule out MI or other acute coronary syndromes NOT a candidate for acute reperfusion therapy

Ischemic ECG :

Ischemic ECG

The 12-Lead ECG:

The 12-Lead ECG Suspicious for injury: ST elevation Evidence of acute myocardial infarction Candidate for acute reperfusion therapy

12-Lead ECG:

12-Lead ECG Evidence of Acute MI Persistent anginal chest pain or its equivalents ST segment elevation of 1mm or more in two anatomically contiguous leads These patients should receive acute reperfusion therapy

Injury:

Injury

Bundle Branch Block (BBB):

Bundle Branch Block (BBB) New or presumably new Candidate for acute reperfusion therapy May mask or mimic acute ECG changes

Slide 16:

AV Node RBB Block LBB LV Depolarization RV Depolarization Asynchronous depolarization of the ventricles widens the QRS (120ms) BBB

BBB Identification:

BBB Identification Supraventricular rhythm Wide QRS (120ms or more)

BBB:

BBB May be old If not proven to be old, assume it is new If story and risk factors suggest MI, treat new or assumed to be new BBB as ST elevation Seek most recent ECG

BBB:

BBB

Slide 20:

Fibrinolytic Therapy Trialists’ (FIT) Collaborative Group, 1994

12-Lead ECG Subsets:

12-Lead ECG Subsets Chest pain or anginal equivalent suspicious of ischemia Immediate assessment and initial general treatment Assess initial ECG ST elevation or new BBB ST depression or T inversion Nondiagnostic - no ST-T deviation Prepare and evaluate for reperfusion therapy Thrombolytics or primary PTCA

Summary:

Summary ECGs are placed into one of three subsets Infarct may be occurring in any of the subsets ST elevation and BBB Evidence of infarct Subject to acute reperfusion therapy

Prep for Reperfusion Therapy:

Prep for Reperfusion Therapy Notify the hospital Transmit the ECG Screen for thrombolytics Start 2nd or 3rd lines or locks Draw additional labs Defibrillation electrodes

Prep for Reperfusion Therapy:

Prep for Reperfusion Therapy Notify the hospital Transmit the ECG

Prep for Reperfusion Therapy:

Prep for Reperfusion Therapy Screen for thrombolytics General contraindications for thrombolysis Pregnancy Bleeding Recent stroke Recent surgery Blood clotting disorders

Prep for Reperfusion Therapy:

Prep for Reperfusion Therapy Sample check-off lists

Prep for Reperfusion Therapy:

Prep for Reperfusion Therapy Establish multiple IV access sites Suitable lines in suitable vessels At least two Locks or IV fluid Multi-lumen caths Compressible vessels

Prep for Reperfusion Therapy:

Draw additional labs Point of care cardiac markers and glucometer check Initial serum cardiac markers Electrolyte studies Coagulation studies Type & cross match Prep for Reperfusion Therapy

Prep for Reperfusion Therapy:

Apply defibrillation electrodes High risk for lethal dysrhythmias Helps avoid unnecessary CPR Standby pacing Prep for Reperfusion Therapy

Reperfusion Decisions:

Reperfusion Decisions Select reperfusion strategy Thrombolytic (in field or hospital) PTCA Select transport destination If thrombolytics contraindicated, is emergency PTCA available? Local protocols

Transport Destination:

Contraindications for thrombolysis? Transport Destination Thrombolysis ST elevation or new BBB Yes No PTCA

Module 4: Case 1:

Module 4: Case 1 71 year old female, c/o weakness x 4h. No other symptoms P 68, RR 16 and effortless, BP 160/110 Awake and alert, skin warm and dry

Module 4: Case 1 :

Module 4: Case 1 Risk factors: Advanced age

Module 4: Case 1:

Module 4: Case 1

Evaluate Case 1:

Evaluate Case 1 Story Risks ECG

Module 4: Case 2:

Module 4: Case 2 58 year old female, sudden onset of central, dull, chest pain rated as 4/10. Onset 12 minutes prior to your arrival Also c/o brief dizziness at onset of pain History of hysterectomy and peptic ulcer each over 10 years ago RR 18, P 80, B/P 140/70, Sa0 2 98%

Module 4: Case 2 :

Module 4: Case 2 Risk factors: Smokes two packs per day Extensive family history of early coronary artery disease

Module 4: Case 2 :

Module 4: Case 2

Evaluate Case 2:

Evaluate Case 2 Story Risk factors ECG

Module 4: Case 3:

Module 4: Case 3 67 year old female C/O left sided chest pain 7/10 for 2 hours, unrelieved by 3 NTG R 18, P 80, BP 150/76, Sa0 2 95%

Module 4: Case 3 :

Module 4: Case 3 Risk factors Diagnosed coronary artery disease Hypertension

Module 4: Case 3:

Module 4: Case 3

Evaluate Case 3:

Evaluate Case 3 Story Risk factors ECG

Module 4: Case 4:

Module 4: Case 4 68 year old male, c/o chest pressure 8/10 for 15 minutes. Accompanied by mild dyspnea and a sense of doom R 20, P 70, BP 160/110, Sa0 2 88% on room air, slight basilar rales Skin moist, pale

Module 4: Case 4:

Module 4: Case 4 Risk factors: Age History of hypertension Obese (255 lbs. at 5 ft. 8 in.) Nonsmoker Has never had lipid profile

Module 4: Case 4:

Module 4: Case 4

Evaluate Case 4:

Evaluate Case 4 Story Risks ECG

Summary:

Summary Story + Risk factors + ECG = Treatment