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Chest Pain Scenario (ECA)

Chest Pain Scenario (ECA)

You are working with your regular Paramedic crewmate and are called to a 56-year-old male with chest pain. On arrival, you complete your OPQRSTA questioning and find that the patient has sudden onset, crushing central chest pain radiating to his jaw, which began 30 minutes ago while gardening. He appears slightly clammy, short of breath, and mildly nauseated.

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Question 1 of 15

1. Question

You complete your observations while the Paramedic performs a 12-lead ECG. The observations are: HR 98, RR 24, SpO₂ 96%, BP 103/76, Temp 36.5°C, BM 6.4, GCS 15.
What is his NEWS score?

4
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6
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3
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2
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Question 2 of 15

2. Question

Does a NEWS score apply to this patient?

Yes, it is a tool used for identifying acutely unwell patients and tracking deterioration
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No, the patient doesn’t have signs of infection or sepsis so the tool doesn’t apply
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Question 3 of 15

3. Question

The patient has a past medical history of stable angina, hypertension, a TIA 5 years ago, diabetes, and high cholesterol. His pain has remained constant at 7/10 on the NPS scale, and he took his GTN spray twice just before your arrival. Given a standard GTN spray bottle, what dose did the patient take?

800mcg
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400mcg
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200mcg
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600mcg
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Question 4 of 15

4. Question

He took his GTN spray 5 minutes after the onset of pain. It has eased slightly and is more bearable, but the pain remains. He has rested since the onset, but it has only been 30 minutes. This is like other recent episodes, and he states he has not sought medical assistance as it usually disappears after a few hours and a few extra sprays. Does this episode sound more like stable or unstable angina?

Unstable angina
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Stable angina
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Question 5 of 15

5. Question

Both stable and unstable angina, alongside STEMIs and NSTEMIs, are all categorised under Acute Coronary Syndrome (ACS).

False
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True
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Question 6 of 15

6. Question

Your colleague asks you to place posterior ECG leads, as you can place ECGs but not interpret them. What does this entail?

Switching V4–6 to V7–9 under the left scapula on the patient’s back
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Switching V1–3 to V7–9 under the left scapula on the patient’s back
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Switching V3–4 to V3R and V4R
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Switching V1–2 to V3R and V4R to mirror V3–4 on the right side of the patient’s chest
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Question 7 of 15

7. Question

He also asks whether you could give the patient an Aspirin. What is the initial dose for a suspected MI in the pre-hospital setting?

300mg
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150mg
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75mg
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600mg
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Question 8 of 15

8. Question

The Paramedic begins calling PPCI, suspecting a Posterior MI due to ST-elevation in V7–9. What sign did they likely recognise in the first ECG that prompted the need for a posterior ECG?

ST depression in V1–3
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ST elevation in leads II, III and aVF
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ST elevation in I, aVL, V5–6
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ST depression in leads II, III and aVF
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Question 9 of 15

9. Question

What is the most appropriate initial oxygen therapy for this patient?

Oxygen only if saturation drops below 94%
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High-flow oxygen via non-rebreather mask at 15 L/min
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Nasal cannula at 2 L/min
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Venturi mask at 24%
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Question 10 of 15

10. Question

The patient’s saturations remain 96%, so you do not apply oxygen. What other actions could you assist with while your colleague refers to PPCI and gains IV access?

Defibrillator pads applied during transfer
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Reassure the patient and any family
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Get a chair for extrication
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Ibuprofen administration
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Get the patient’s shoes so they can walk to the ambulance
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Help the patient lie down so you can raise their legs
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Question 11 of 15

11. Question

What treatments would you expect the Paramedic to potentially administer when transferring to a PPCI unit?

Morphine
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GTN
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Ondansetron
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Prednisolone
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Hydrocortisone
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Question 12 of 15

12. Question

Monitoring the patient’s ECG and taking further 12-lead ECGs after diagnosis can help monitor the progression of the MI and guide or prompt treatment.

True
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False
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Question 13 of 15

13. Question

Why can a patient’s history of diabetes be relevant in this scenario?

Diabetics often have atypical or ‘silent’ symptoms of MI
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They are less likely to experience an MI
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Aspirin is contraindicated
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It is not relevant
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Question 14 of 15

14. Question

Which of the following are risk factors for heart disease?

All of the listed
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Smoking
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Excessive alcohol intake
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Sedentary lifestyle
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Diabetes
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High blood pressure
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High cholesterol
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Increased stress
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Family history
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Question 15 of 15

15. Question

According to JRCALC and European Society of Cardiology guidelines, how long should it take to obtain an ECG after first patient contact?

Within 10 minutes
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Within 30 minutes
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Immediately
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