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!!