D) 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, This is an example of which type of heart rhythm? Having to adjust medication regimens based on which cardiologist is on call, instead of patient-based characteristics, is a recipe for error. A) Maintain blood pressure. Ventilations, compressions In confirming and monitoring placement of the ET tube, the 2015 ACLS guidelines suggest what? *Power on the AED, attach electrode pads, analyze the rhythm, and shock the individual. All of the following are found within the 8 Ds of Stroke Care EXCEPT: The chambers of the heart responsible for circulating deoxygenated blood from the systemic circulation to the pulmonary circulation are the following: The normal sinus rhythm of the heart starts in the: Under normal circumstances, what is the largest chamber of the heart? C) A facility that performs PCI An ongoing question related to intra-arrest transport and early invasive treatment for refractory OHCA is the timing of when such an approach should be considered. It also strongly suggests that dual antiplatelet therapy with aspirin and an ADP receptor antagonist be initiated prior to the use of bivalirudin in the cath lab due to increased rates of ischemic events when bivalirudin was utilized as monotherapy in the ACUITY trial. A) Delivery Urgent defibrillation is essential for survival in the management of acute strokes. A) 50 beats per minute Heart disease, which includes acute coronary syndromes (ACS), is the leading cause of death in the United States. What do you suspect is the most likely diagnosis? National Heart, Lung, and Blood Institute. ventricular filling, and reduced cardiac output? Percutaneous coronary intervention (PCI) is the first-line treatment for patients with ACS. B. True or False: If the AED advises no shock, you should still 2. These Level 3 Reference Series speaker wires are essentially two sets of the 7 time Award Winning (see below) ANTICABLES speaker wires built into one.So instead of having two #12 gauge wires running to each speaker, there are four #12 . decreased systemic arterial pressure. They include: Chest pain or discomfort is the most common symptom. 122. Aspirin is the first choice for platelet inhibition in suspected cases of ACS. http://www.heart.org/HEARTORG/Conditions/HeartAttack/%20PreventionTreatmentofHeartAttack/Cardiac-Medications_UCM_303937_Article.jsp#.XG37pKJKjIU. True or False: Fibrinolytic therapy within three hours (in some cases 4.5 hours) of first onset of symptoms is the standard when treating ischemic stroke. Cardiac medications. All patients presenting with suspected ACS should receive 162-325 mg of aspirin unless they are allergic. 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. STEMI- local reperfusion protocol (fibrinolysis, local PCI, or transfer for primary PCI) should be initiated immediately upon identification. Right or left B) Give one breath every 5 to 6 seconds, or 10 to 12 breaths per minute. B) Epinephrine When using a monophasic defibrillator, how many joules should be delivered per shock? True or False: An individual in PEA has an organized cardiac narrowed arteries then we can do the procedure immediately . True or False: Transcutaneous pacing should be used on an individual with bradycardia and inadequate perfusion if atropine is ineffective and the individual is exhibiting severe symptoms. Fondaparinux is a competitive inhibitor of factor Xa in the coagulation cascade, but it does not act against thrombin that is already in the coronary thrombus. The American Colonization Society (ACS) was formed in 1817 to send free African-Americans to Africa as an alternative to emancipation in the United States. Given the simplicity of calculating a TIMI score, and given that TIMI has been validated in an ED population of non-specific chest pain, the TIMI score is preferred by the author. Ventricular fibrillation can be a life-threatening complication of ACS. . Explain why these are true or false. Ischemic stroke is caused by the occlusion of an artery. True or False: Any bradycardia less than 60 beats per minute is Surgery books by dr, - Anatomy books by, PALS: Qquestion and Answer by (NHCPS) True or False: Shock may o, Internal Medicine Books, Dr. Ahmed Mowafy (2020-2021) /, : ( , , Internal medicine Books Dr. Mahmoud Allam (2021) /, Download FREE Videos & PDFs of Board and Beyond USMLE STEP 1 . The management for this condition is as follows: The American College of Cardiology / American Heart Association guidelines for NSTEMI / unstable angina list the following characteristics as indicative of a high risk presentation: In addition, the ACC/AHA guidelines recommend the calculation of a risk stratification score as part of the initial assessment of a patient with suspected ACS. Ischemic heart disease may lead to myocardial dysfunction, which may lead to signs and symptoms of acute heart failure. Many of these agents are cleared renally, and dosing should be adjusted in patients with renal insufficiency. B) Shortness of breath Open navigation menu After the initial risk stratification assessment, a substantial portion of patients will be deemed low risk for ACS (negative initial cardiac biomarkers, non-ischemic ECG, and low risk stratification score). True or False: A nasopharyngeal airway (NPA) can be used on a Did the patient have an appropriately elevated heart rate such that the test could have been diagnostic? D) Head-tilt-chin-lift maneuver, According to the 2015 ILCOR update, high-quality CPR is defined as: Accessed Feb. 20, 2019. 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. but constant heart rate between 80 and What is caused by an accumulation of blood in the pericardial Administer atropine. The following are 10 points to remember about this guideline from the American College of Cardiology/American Heart Association on the management of patients with non-ST-elevation acute coronary syndromes (NSTE-ACS): 1. critical to individual's survival. American Heart Association. 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. What is the evidence for specific management and treatment recommendations? ACS patients may have either STEMI or non-ST-elevation ACS, which includes NSTEMI or unstable angina. Hyperventillation (over ventillation) can be harmful because it: What reason is NOT valid during the critical early defibrillation for individuals experiencing sudden cardiac arrest? In a bradycardic individual who is symptomatic and does not Controversy exists regarding the necessity of rapid reperfusion in NSTEMI, although the American College of Cardiology / American Heart Association (ACC/AHA) guidelines do recommend an early interventional strategy for those patients with evidence of myocardial necrosis, as demonstrated by elevated cardiac biomarkers. Power on the AED, shock the individual, attach electrode pads, and analyze the. For patients with acute chest pain and suspected ACS who have new ischemic changes on electrocardiography, troponin-confirmed acute myocardial injury, new-onset left ventricular systolic dysfunction (ejection fraction <40%), newly diagnosed moderate-severe ischemia on stress testing, hemodynamic instability, and/or a high CDP risk score should . C. The individual becomes pulseless Acute Coronary Syndrome: What every physician needs to know. Food components may affect digestion and cause functional abdominal disorders of the IBS spectrum . Which of the following is a correct statement regarding sinus tachycardia? Pain / discomfort, shortness of breath and other symptoms which are assessed as probable non- ACS (after thorough assessment) should be treated as per the appropriate guideline /s (e.g. 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. Pneumonia pneumonia typically presents with fever, cough, and dyspnea with sputum production. Massive pulmonary embolism Therefore, while publicly reported performance data may not refer specifically to individual results, we are all responsible for providing evidence-based, guideline recommended elements of medical care. PCI techniques have become established. Patients with an explicitly documented contraindication for aspirin use will be excluded from this measure. False Which of the following may be essential to maintain an individual's airway open? Administer epinephrine. Low risk ACS- negative ECG and biomarkers, low risk per risk stratification tool. True A patient may report a previous negative cardiac catheterization that, upon further review, is actually positive for coronary artery disease that did not warrant mechanical intervention at that time. The signs and symptoms of acute coronary syndrome usually begin abruptly. 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. Patients should receive aspirin therapy within 24 hours of arrival (by patient or by EMS) in the ED or within 24 hours after presentation. Beta-blockers, calcium channel blockers, ACE inhibitors, and nitroglycerin all may cause a drop in blood pressure, especially in patients with right ventricular ischemia. Troponin should be measured at 0 and 6 hours if a standard cTn assay is used. High risk ACS- high risk features or a high risk for adverse outcomes per validated risk stratification score such as TIMI or GRACE. ACS is required to investigate all reports received. of ventricular fibrillation? This is a non-antigen mediated response, and traditional anaphylactic treatments have little effect. D) Administer a calcium channel blocker. Right ventricular infarction may, however, manifest itself as ST segment depression in the lateral leads. A heart attack (also called a myocardial infarction or MI) is defined by evidence of heart damage, shown by release of cardiac biomarkers, in the presence of poor blood supply (ischaemia). Symptomatic bradycardia and poor perfusion may degrade into cardiac arrest. B) Metoprolol the following should be done: Immediately resume CPR and switch to ACLS cardiac arrest + Surgery books by dr. mohamed al matary, - ( ) Anatomy books by dr. Sameh doss, Internal Medicine Books, Dr. Ahmed Mowafy (2020-2021), : ( ), OET , Internal medicine Books Dr. Mahmoud Allam (2021), Download Boards & Beyond USMLE Step 1. defibrillate because defibrillation often restarts the heart with D) Defer cardioversion until symptoms become irreversible. Unfortunately, this does not mean that the absence of CAD risk factors equals the absence of risk for ACS. FALSE One type of acute coronary syndrome is STEMI. As the interval from presentation to intervention increases, so does the patient benefit realized from appropriately aggressive antiplatelet and anticoagulation regimens initiated early in the ED and hospital course. See Answer Looks like youre enjoying our content Youve viewed {{metering-count}} of {{metering-total}} articles this month. However, factor Xa assays can be used if available and necessary to assess the extent of anticoagulant activity provided by LMWH. Retrospective cohort studies have demonstrated an association between morphine use and mortality in ACS. Which is NOT an SI base unit? CK should not be used by itself to diagnose MI. However, VQ scanning will not provide information regarding alternate diagnoses, such as occult pneumonia or aortic dissection, that can be discovered on CT. False Which of the following can be a result of prolonged Symptoms suggestive of ACS may include all of the following EXCEPT: *Headache and blurry vision Chest discomfort with lightheadedness, sweating, or nausea Unexplained shortness of breath with or without chest discomfort Uncomfortable pressure in the center of the chest CORRECT What is the only means of identifying ST-elevation MI (STEMI)? It is obvious that results attributed to an institution are generated from the actions of individuals. How many additional dollars of You are responsible for planning your familys next summer Diagnostic confirmation: are you sure your patient has ACS? The 2010 AHA Guidelines for CPR and ECC for the evaluation and management of acute coronary syndromes (ACS) are intended to define the scope of training for healthcare providers who treat patients with suspected or definite ACS within the first hours after onset of symptoms. Antiplatelet agents work on the various receptors on the platelet surface to inhibit successful platelet aggregation, whereas anticoagulants will target the thrombin-fibrin cascade along different points, depending on the agent. True However, these are speculations, and the relationship between opiate use and mortality has not been fully explored. 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