Agenda

• Quiz• Scenario– There will be 1 patient and 1 proctor• If score less than 80%, switch roles and do scenario

again

• Lecture• Write-ups• Next week

Angina vs. MI• Causes

– MI: complete blockage of the blood supply to the heart muscle– Angina: decrease in blood supply to the heart

• Symptoms– MI: chest pain with damage to the heart

• Severe, steady, crushing pain• Radiates to the left neck• Weak, rapid pulse• Hypotension• Low grade fever

– Angina: best pain with no damage to the heart• Tightness or pressure in the chest

• Severity– MI: may cause permanent damage

• irreversible damage prevented if blood supply restored within 20 min• Symptoms persist after 15 minutes and not relieved by nitro

– Angina: symptoms relieved by rest or nitro within 10-15 minutes

Medications• Administration criteria (DICE)

– Drug/Dosage– Integrity/Indications (right patient?)– Clarity/Contraindications– Expiration Date

• Nitroglycerin– Take BP before administration and 5 minutes after administration

• Why?– May cause hypotension due to vasodilation

– Indications• Symptoms of chest pain• Systolic BP >100mm/Hg

– Contraindications• Patient does not meet indication or criteria for administration

Patient has taken 3 doses before EMS arrival within the last 5 minutes Last dose was < 5 minutes ago

Systolic blood pressure < 100mm/Hg Administration of Sildenafil citrate (Viagra7) or similar medication within 36 hours

Medications

• Preparation/administration– Tablet• Remove from container and check if in tact• Place under pt’s tongue• Instruct patient to allow tablet to dissolve, not swallow

– Spray• One spray delivers 0.4 mg of nitro sublingually

Reassessment

• Repeat every 5 minutes– AKA primary assessment– Vital signs– Relevant part of a secondary assessment

STS Dates• Every week (mostly)

– 1/21– 1/28– 2/4– 2/11– 2/18– 2/25– 3/4– 3/25– 4/1– 4/8– 4/22– 4/29 (elections)

See you next week!!