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“Just Say Know!”

“Just Say Know!”. Pharmacology in ACS. About ME. Julie Williams, NREMT-P, NCEE Beaufort County EMS Training Coordinator. Beaufort. Case #1.

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“Just Say Know!”

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  1. “Just Say Know!” Pharmacology in ACS
  2. About ME Julie Williams, NREMT-P, NCEE Beaufort County EMS Training Coordinator
  3. Beaufort
  4. Case #1 You respond to a 83 y/o male c/o substernal chest pain (10 on pain scale) throughout the day. Upon arrival you find the patient sitting in his recliner. He is COA and appears pale and diaphoretic. Patient states “all I need is a nitro and I’ll be fine”.
  5. Case#1 cont. Vital signs B/P - 156/72 HR - 56 R - 20, non-labored, lungs clear Skin – pale, cool diaphoretic
  6. 12 Lead EKG
  7. Right Side V4R
  8. M O N A
  9. AHA
  10. 2005 2010
  11. Morphine
  12. What’s it do Analgesic Reduces preload Reduces dyspnea associated with LVF and Pulmonary Edema
  13. However Myocardial depressant Increases mortality in UA/NSTEMI Cannot be used in CHF
  14. The Study CRUSADE A National Quality Improvement Initiative Duke University Medical Center 57,000 ACS patients admitted to one of 433 hospitals Death or MI with no Morphine 7.1% Death or MI after Morphine 8.7%
  15. Can it Hurt???
  16. Rationale To correct SaO2 <90% ACC/AHA 2007 guidelines class I ALL NSTEMI/ uncomplicated STEMI Class IIb Increase in O2 = decrease in ischemia Ventilation-perfusion mismatch Pulmonary edema
  17. However…. Hyperoxia decreases CBF Increases vascular resistance Increases blood pressure Increases heart rate Decreases myocardial O2 consumption
  18. Pre-admission
  19. Admission
  20. Nitroglycerin
  21. Nitroglycerin Vasodilator Increases coronary blood flow Reduces ischemic pain Reduces preload
  22. Nitroglycerin Actions Decrease coronary vasoconstriction or spasm Increase myocardial perfusion Decrease Oxygen demand Decrease preload Tolerance
  23. Vasodilation Reduced Preload Hypotension DEATH
  24. Precautions Phosphodiesterase inhibitor Viagra, Levitra <24 hours Cialis <48 hours SBP <90 mmHg HR <50 bpm RVI
  25. Tolerance Develops rapidly Blood vessels become desensitized to vasodilation “Nitro-free interval” 10 to 12 hours
  26. Aspirin
  27. Aspirin Platelet inhibitor Used with fibrinolytic therapy Reduced nonfatal MI by 30% Reduced vascular death by 17% Aids streptokinase
  28. Precautions “True” allergy Active peptic ulcer Severe hepatic disease
  29. Case #1 Review Oxygen (capnography) Aspirin IV’s Fluid Bolus Dobutamine
  30. QUESTIONS ?
  31. Thank you!!! Julie Williams, NREMT-P, NCEE Beaufort County EMS Training Coordinator j_williams01@hargray.com
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