5.4 Acute Cardiopulmonary Emergencies: STEMI, Stroke & PE

🎯 Key NCLEX-RN® Clinical Takeaways

• STEMI requires emergent PCI within 90 minutes door-to-balloon time; do not delay reperfusion waiting for cardiac enzymes.
• Alteplase (tPA) for ischemic stroke: symptom onset < 3 to 4.5 hours, head CT negative for hemorrhage, BP controlled < 185/110 mm Hg.
• Pulmonary embolism presents with sudden dyspnea, pleuritic chest pain, tachypnea, and clear lung sounds; give high-flow O2 and heparin.
• Chest tube water seal: Tidaling with respiration is NORMAL; continuous bubbling in the water seal indicates an AIR LEAK.

Cardiovascular and pulmonary emergencies require rapid, protocolized intervention. STEMI represents complete epicardial coronary occlusion; the catheterization lab must be activated immediately to achieve reperfusion within 90 minutes.

Acute ischemic stroke management follows the 'Time is Brain' mandate. Intravenous alteplase dissolves occluding thrombi if given within 3 to 4.5 hours of symptom onset, provided intracranial hemorrhage is excluded on CT.

Pulmonary embolism creates acute right ventricular strain and hypoxemia. Chest drainage systems require careful surveillance: tidaling confirms patency, while continuous water-seal bubbling signals an air leak.

⚠️ Common Pearson VUE / NCLEX Traps

• Administering aspirin, clopidogrel, or heparin within 24 hours of alteplase (tPA) infusion.
• Clamping chest tubes during patient transport, which converts a simple pneumothorax into a fatal tension pneumothorax.