Typical chest pain in acute MI has the following characteristics
A.
Intense and unremitting for 3060 minutes
B.
Substernal, and often radiates up to the neck, shoulder, and jaw, and down the left arm
C.
Usually described as a substernal pressure sensation that also may be characterized as squeezing, aching, burning, or even sharp
D.
In some patients, the symptom is epigastric, with a feeling of indigestion or of fullness and gas
E.
Nitroglycerin for active chest pain, given sublingually or by spray
2.
The patient’s vital signs may demonstrate the following in MI:
A.
The patient’s heart rate is often increased (tachycardic) secondary to a high sympathoadrenal discharge
B.
The pulse may be irregular because of ventricular ectopy, an accelerated idioventricular rhythm, ventricular tachycardia, atrial fibrillation or flutter, or other supraventricular arrhythmias; bradyarrhythmias may be present
C.
In general, the patient's blood pressure is initially elevated because of peripheral arterial vasoconstriction resulting from an adrenergic response to pain and ventricular dysfunction
D.
However, with right ventricular MI or severe left ventricular dysfunction, hypotension and cardiogenic shock can be seen
E.
The ECG is the most important tool in the initial evaluation and triage of patients in whom an acute coronary syndrome (ACS), such as MI, is suspected. It is confirmatory of the diagnosis in approximately 80% of cases.
3.
For patients with chest pain, prehospital care includes the following:
A.
Intravenous access, supplemental oxygen if SaO2 is less than 90%, pulse oximetry
B.
Immediate administration of nonentericcoated chewable aspirin
C.
Nitroglycerin for active chest pain, given sublingually or by spray
D.
Telemetry and prehospital ECG, if available
E.
Lipid profile
4.
Laboratory tests used in the diagnosis of MI include the following:
A.
Cardiac biomarkers/enzymes:
B.
Troponin levels
C.
Complete blood cell count
D.
Comprehensive metabolic panel
E.
Intravenous access, supplemental oxygen if SaO2 is less than 90%, pulse oximetry
