Managing Myocardial Infarctions.pptx

7/27/2019 Managing Myocardial Infarctions.pptx

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Myocardial Infarction (MI)

aka

Acute Myocardial Infarction (AMI)

aka

HEART ATTACK


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Interruption of blood flow to the heart muscle thatresults in tissue necrosis

Can be preceded by cardiac ischemia

Can cause cardiac arrest.

Medical Emergency! Admit to hospital.

Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15.
http://www.focusonfirstaid.co.uk/Magazine/issue15/index.aspxhttp://www.focusonfirstaid.co.uk/Magazine/issue15/index.aspx


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Hypotension

Pale Skin

Palpitations

Sweating Chest pain

SOB

Nausea and Vomiting

Lightheadedness

Can proceed to LOC and sudden death.Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15.


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To save as much muscle as possible

Prevent further complications

Eg CHF, arrhythmia, pericarditis.

Mallinson, T (2010). "Myocardial Infarction". Focus on First Aid (15): 15.


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ABCs: assess and correct hemodynamic statusfirst

bed rest, cardiac monitoring, oxygen

nitroglycerin SL followed by IV

morphine IV

Time is Muscle


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ECG MI can have ST elevation (STEMI) or noST Elevation (NSTEMI).

Monitor ST segment continuously if patient isin pain.

Cardiac Biomarkers CK MB, Troponins

Get Baseline bloods, including lipid profile.


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Chest pain lasts more than 20 minutes

Opiates more effective than sublingual GTN

Atypical symptoms like syncope and dyspnoeaseen in the elderly and diabetic patients.

ST elevation seen on ECG

REF: Kumar and Clarks Clinical Medicine


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Determine if the patient is at high risk ofcomplications.

Scoring systems include:

Thrombolysis In Myocardial Infarction (TIMI) score

Global Registry of Acute Coronary Events (Grace)

REF: Kumar and Clarks Clinical Medicine


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Low Risk patients Drugs alone

Medium risk patients early coronary

angiography + Drugs

High Risk Patients urgent coronary

angiography, refer for CABG.


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Requires thrombolysis. NSTEMI does not.

aspirin 150300 mg clopidogrel 300 mg

SL GTN 0.31 mg

oxygen nasal cannula 24 L/min (Fig. 15.21)

H + E and risk calculation


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Large bore IV access + blood for markers

12-lead ECG

IV Opiate + antiemetic

beta-blocker, if not contra-indicated.


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Beta Blocker

Clexane

Morphine + Gravol

Oxygen ASA

Nitrates

Statins ACEi

On call with Ward 9, SFGH.


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Pt comes in with symptoms of ischemia

Monitor to differentiate STEMI from NSTEMI

Thrombolysis is for STEMI only

Drugs used for MI include ASA, GTN,Morphine + gravol, O2 and beta blockers.

High risk patients need angioplasty or CABG.


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Mallinson, T (2010). "Myocardial Infarction".Focus on First Aid (15): 15.

Kumar and Clarks Clinical Medicine, 8th

Edition. Saunders Ltd. Davidsons Principles and Practice of Internal

Medicine.

http://www.timi.org/ Wikipedia Commons (image)


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Managing Myocardial Infarctions.pptx

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