There are a few special points to consider in this case. True or False: PALS management of respiratory distress/failure B) Endotracheal tube (ET tube) cycle of CPR. individuals with acute stroke ? Evidence suggests that this agent is best suited for initiation in the cath lab. This can occur when a clot forms in one of the heart's coronary arteries and blocks the blood supply to part of the heart muscle. Security Consultant with 18 years of intensive experience in Cloud security, Cyber Security, Telecom Security, SDN/NFV, IaC, DevSecOps, Telco Cloud, AWS, Automation & Beyond which has been gained in multiple roles in Cyber/Information security architecture, operations, support, service management, consulting and building enterprise, ISP and Mobile backbone networks. Defibrillators have two different designs for delivering energy. In an individual with ventricular fibrillation (VF), what should occur immediately following a shock? decreased systemic arterial pressure. Even in the setting of coronary catheterization, it may be difficult to determine if a visualized coronary lesion is responsible for the symptoms. Sit down If the patient was transferred in 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 not apply. AFS-300. A) Sinus tachycardia only results from strenuous exercise or high stress situations. Synchronized cardioversion is appropriate for treating an unknown wide complex tachycardia. There is also a theoretic risk of critical hypertension and vasospasm when pure beta-blockers are administered in the setting of acute cocaine toxicity. Advertising revenue supports our not-for-profit mission. Although there is a typical pattern of ACS symptoms, the absence of these symptoms, or the presence of atypical symptoms, is not enough to rule out ACS. However, factor Xa assays can be used if available and necessary to assess the extent of anticoagulant activity provided by LMWH. 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? Amsterdam, EA, Kirk, JD, Bluemke, DA. QRS complex After arrival of an acute stroke individual in the ED, in what True or False: Synchronized cardioversion is appropriate for D) Right ventricle. Acute coronary syndrome risk factors include: Mayo Clinic does not endorse companies or products. C) They account for 80% of all strokes and are caused by an occlusion of a vein to a region of the brain. sal-ns-acls. See Answer three components: Routinely monitor and assess patients receiving the local Suspected ACS-AP; continuously evaluate adherence to the Suspected ACS-AP; conduct ongoing assessment of the 30-day outcome associated with the application of the Suspected ACS-AP. Ductal-dependent congenital heart lesions B) Advanced airway insertion False Patients without high risk features but with increased risk for ACS as characterized by a validated risk stratification score may be managed utilizing an initially conservative strategy and diagnostic protocol. Many of these agents are cleared renally, and dosing should be adjusted in patients with renal insufficiency. 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. Which of the following can be a result of prolonged *Elevated troponin defined as >99th percentile of a normal reference population. Patients who receive primary fibrinolysis who are then transferred are not included in this measure. C. History part 3: competing diagnoses that can mimic ACS. Ventilation-perfusion (VQ) scanning is an alternative when there are contrast contraindications, such as renal insufficiency or dye allergy, and was the mainstay of PE diagnosis for years before the advent of CT angiography. False Their sensitivity for predicting coronary stenosis ranges from 85%-90%. Tension pneumothorax D) Start CPR. True or False: 100% oxygen is acceptable for early D) Suctioning, What item is NOT an example of Advanced Airways? STEMI is defined by >1mm/0.1mV elevation of the ST segment in two or more contiguous leads on an ECG. Patients with an explicitly documented contraindication for aspirin use will be excluded from this measure. A) 150 beats per minute D) Acute stroke, Within what time period of arrival to the ED is percutaneous coronary intervention (PCI) recommended for STEMI individuals? Cocaine use can cause ACS by inducing coronary vasospasm, dissection, thrombosis, positive chronotropic and hypertensive actions, and direct myocardial toxicity (Section 7.10). Chest pain or discomfort can be a sign of any number of life-threatening conditions. There are a variety of medical conditions and targeted interventions about which the provider can report data. 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. An old highway is built out of concrete blocks of equal length. Low blood pressure may be an indication of hemodynamic instability. defibrillate because defibrillation often restarts the heart with A) Delivery 2. Therefore, if a recent stress test was adequate, doing another is unlikely to produce results that will alter management. 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. Consider accelerated diagnostic protocol, recurrent ischemic chest pain despite ongoing medical management, pulmonary edema or new mitral regurgitation murmur, recent PCI (less than 6 months) or previous CABG, established systolic heart failure (EF<40%), bradycardia (especially with right coronary involvement affecting the sinoatrial pacemaker), back or hip pain, suggestive of potential retroperitoneal hematoma, bleeding at the site of vascular access catheters. C) Obtain a coronary CT scan. C) None of the above A) Start with chest compressions instead of two rescue breaths. True or False: One type of acute coronary syndrome is STEMI. Transient ST segment elevation, ST segment depression, or t-wave inversion may occur, but may also be absent. A) Left atrium True or False: A nasopharyngeal airway (NPA) can be used on a Definitions The term acute coronary syndrome (ACS) is applied to patients in whom there is a suspicion or confirmation of myocardial injury. A) Rescue breaths Airway, What does the PR interval on an ECG reflect? Which is NOT an SI base unit? Drug-coated balloon (DCB) technology was developed to deliver the antiproliferative drugs to the vessel wall without leaving any permanent prosthesis or durable polymers. C) Conduction through the AV node You are alone when you encounter an individual in cardiac Beta blockade is indicated in all patients recovering from an ACS event, in the absence of contraindications. Right ventricular infarction may, however, manifest itself as ST segment depression in the lateral leads. The majority of the measures relevant to the ED setting are in reference to STEMI. Traditional risk factors help identify patients at risk for developing CAD, although they are of limited value in determining whether the patient presenting with acute chest pain is experiencing ACS. Hyperventillation (over ventillation) can be harmful because it: What reason is NOT valid during the critical early defibrillation for individuals experiencing sudden cardiac arrest? immediately CPR should be started to reactivate the heart . Pain relief should be offered as soon as possible with glyceryl trinitrate (sublingual or . Rarely, beta-blockers may precipitate bronchospasm in patients with uncontrolled COPD/asthma. B) Ventilations, compressions Scribd is the world's largest social reading and publishing site. 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? 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. ACE inhibition- patients with a history of diabetes or heart failure should be discharged on an ACE inhibitor (or ARB if ACE is not tolerated). B) Metoprolol As a large number of MI arise from non-obstructive plaques, the presence of non-obstructive CAD on a previous anatomic study should encourage the physician to maintain ACS in the differential. All patients presenting with suspected ACS should receive 162-325 mg of aspirin unless they are allergic. D) Septum wall, During a tachycardic episode, if the individual ____________ at any point, you must switch algorithms. narrowed arteries then we can do the procedure immediately . Therefore, if a transition is planned for angiography with intent to perform PCI, it is recommended that at least 8 hours lapse between the last dose of LMWH and the initiation of UFH. Asystolic rhythms can result in severe myocardial Chest pain (angina) or discomfort, often described as aching, pressure, tightness or burning, Pain spreading from the chest to the shoulders, arms, upper abdomen, back, neck or jaw, Family history of chest pain, heart disease or stroke, History of high blood pressure, preeclampsia or diabetes during pregnancy. C) 10 minutes D) Faster access to medications that increase blood clotting, C) Saving more heart tissue from cell death, Serious signs and symptoms of unstable tachycardia are usually NOT seen with ventricular rates less than: A) Vital organs can be permanently damaged. C) Sinus bradycardia the QRS wave is ___________in a tachycardic individual. D) Left atrium and left ventricle, What does the QRS represent? By 1867, the society had sent more than 13,000 emigrants. Comorbidities, such as COPD with chronic dyspnea and sputum production but an increase in chest discomfort, may complicate the assessment. 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. A) To protect the brain/organs Soman P, et al. Recommendations are graded both on the strength of the recommendation and the level of evidence. Unless there is an allergy-based contraindication, aspirin should be used concomitantly to provide dual-agent antiplatelet activity. C) 70 beats per minute I need all the questions to answer, please Urine drug screen testing may identify the presence of cocaine or methamphetamine as precipitants of cardiac ischemia. Coins can be redeemed for fabulous For an individiual in respiratory arrest with a pulse, how often should they be ventilated? E. What diagnostic tests should be performed? Journal of Clinical Medicine. Why should therapeutic hypothermia be considered in an adult comatose person during the post-cardiac arrest period? The BLS Survey includes assessing which of the following? 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. to: A center that has a dedicated stroke team. All of the following are categories of unstable angina EXCEPT: D. Both A and B (The individual suddenly deteriorates & The individual becomes pulseless). 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. : One type of acute cocaine toxicity it may be an indication of instability. 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