Agenda

2. 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

3. 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

4. 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

5. 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

6. Reassessment • Repeat every 5 minutes • AKA primary assessment • Vital signs • Relevant part of a secondary assessment

7. 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)

8. See you next week!!