Busy. Please wait.
Log in with Clever

show password
Forgot Password?

Don't have an account?  Sign up 
Sign up using Clever

Username is available taken
show password

Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
Your email address is only used to allow you to reset your password. See our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.
Didn't know it?
click below
Knew it?
click below
Don't Know
Remaining cards (0)
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

ER Chest pain

Chest pain labs CBC, CMP, Mag, LFTs, Coags, Cardiac markers, BNP, D-dimer, Urine drug screen, hCG (female)
The big differentials of chest pain ACS, PE, tension pneumo, ruptured esophagus, aortic dissection
Chest pain history Where? Character? How bad? Radiates? Exertional? When? Relief? Associated symptoms?
Chest pain risk factors Prior? HTN, DM, Hyperlipid, Lung dis? Smoke? Recent drugs? Recent illness, injury, surgery? Family MI death < 55?
Admit for chest pain Ill appearing, known heart dis, elderly w/ comorbids, unsure
D/C with close follow up for chest pain Young, healthy, no comorbids
The smaller differentials of chest pain Acute pericarditis, pneumonia, MVP, chest wall pain, GERD, esophageal spasm, PUD, panic d/o
Few seconds duration Less concerning
Several minutes to an hour; relieved by rest or nitro Concerning
Supplies some anterior wall and a large portion of the lateral wall Left circumflex
Supplies the anterior and septum Left anterior descending
Supplies the right side of the heart, and the inferior aspect of the left ventricle through the posterior descending artery Right coronary artery
Pathology of ACS Coronary artery spasm, disruption of atherosclerotic plaque, platelet aggregation, thrombus formation
Ischemia occurs at relatively fixed and predictable points of activity and changes slowly over time Stable angina
Ischemia is relatively unpredictable (ie, at rest) and changes occur rapidly; reversible Unstable angina
Irreversible necrosis Infarction
Usually lasts less than 10 minutes and usually resoves with rest or NTG Angina
Lasts longer than 20 minutes and little to no response to rest or NTG MI
Atypical presentations occur how often 30% - Women, elderly, diabetics
Chest pain with recent angioplasty or stent Assume an abrupt vessel occlusion until ruled out
ST segment depression Subendocardial ischemia
ST segment elevation Acute transmural injury
Q waves Myocardium in the peunumbra has died
Not required if you make the diagnosis on the initial EKG Serum cardiac markers
What is the difference between unstable angina and NSTEMI? Elevated serum cardiac markers (NSTEMI)
Rises in 4-8 hours, peaks at 12-24 hours, returns to baseline in 2-3 days; a rise 5 times above baseline is diagnostic CK-MB
Rises in 6 hours, peaks in 12 hours, returns to baseline in 7-10 days; a rise is diagnostic for AMI Troponin I and T
Potentially protective dysrhythmias in MI Bradydysrhythmias
Dysrhythmias with poor prognosis late in MI Tachydysrhythmias
Results from 40% or more of left ventricular myocardial involvement; will require careful fluid resuscitation and inotropic medications Cardiogenic shock
Most common cause of AMI-related in-hospital deaths Cardiogenic shock
Risk factors for cardiogenic shock Elderly, female, previous MI, CHF, diabetes
Doses larger than 160mg cause immediate, nearly complete inhibition of thromboxane A2; withhold only for true allergy or active PUD Aspirin
Non-aspirin antiplatelet agent associated with a higher risk of bleeding Clopidogrel
Rapid reversal of platelet inhibition after cessation of infusion; offers an advantage during Percutaneous Coronary Intervention (PCI) when bleeding complications occur Glycoprotein IIb/IIIa Inhibitors
Decreases ventricular filling pressures and afterload; decreases cardiac work and myocardial O2 demand; contraindicated with inferior wall MI Nitrates
Nitrates used IV for first 24-48 hrs in AMI and titrated to what? B/P NOT pain relief
Nitrates used IV in UA/NSTEMI if patient does not respond to what? Sublingual nitroglycerin
Decreases anxiety, pain, B/P; start at 2-5mg and titrate Morphine
Diminish myocardial O2 demand by decreasing the heart rate, systemic arterial pressure, and myocardial contractility; given to all ACS patients unless contraindicated Beta-Blockers (Lopressor)
Relative contraindications to beta-blockers Heart rate less than 60, SBP less than 100
Non-cardioselective beta-blockers can block beta-2 subunit receptors resulting in vasoconstriction, bronchospasm, and hypoglycemia; cautious use in: Asthma, IDDM, severe COPD
Specific anti-thrombin agent with unpredictable anticoagulant response due to the mixture of varying molecular weights; indicated for AMI Unfractionated heparin
Specific anti-thrombin agent with greater bioavailability that achieves a more reliable anticoagulant effect; indicated for UA/NSTEMI Low molecular weight heparin
Treatment time is within 6-12 hours of symptom onset and there is at least 1mm of S-T elevation in at least 2 contiguous leads; PCI not available; pain unrelieved with medications Fibrinolytics indicated
Created by: codylarson
Popular Clinical Skills sets




Use these flashcards to help memorize information. Look at the large card and try to recall what is on the other side. Then click the card to flip it. If you knew the answer, click the green Know box. Otherwise, click the red Don't know box.

When you've placed seven or more cards in the Don't know box, click "retry" to try those cards again.

If you've accidentally put the card in the wrong box, just click on the card to take it out of the box.

You can also use your keyboard to move the cards as follows:

If you are logged in to your account, this website will remember which cards you know and don't know so that they are in the same box the next time you log in.

When you need a break, try one of the other activities listed below the flashcards like Matching, Snowman, or Hungry Bug. Although it may feel like you're playing a game, your brain is still making more connections with the information to help you out.

To see how well you know the information, try the Quiz or Test activity.

Pass complete!
"Know" box contains:
Time elapsed:
restart all cards