ACS & STEMI
MI diagnosis has three important components:
1- Biography:
In the history, the typical CP patient mentions:
Typical CP features:
Pain of a pressing nature
Location: retrosternal
Time: more than 30 minutes
It does not respond to rest and TNG
It gets worse with activity (it may feel mild from the previous days)
Accompanying symptoms: sweating – shortness of breath – N/V – anxiety
Radiation: Right hand (more specific), left hand (more common) will not shoot to the trapezius.
2- ECG changes in favor of MI:
STE-T invert -Q
along with specific reciprocal changes
3- Changes in cardiac enzymes:
Troponin: more diagnostic and specific
CK-MB
Important point: If the patient has STE along with TCP, the diagnosis is confirmed and no time should pass for troponin to become positive so that the patient can reach the fibrinolytic golden time.
Order:
Imp: STEMI or ACS
Condition: Urgent/Emergent
Activity: CBR until 12h with BSP
Diet: NPO
The patient should be NPO for 4 hours for solids and 2 hours for liquids. In some sources, the patient should remain NPO for up to 8 hours.
After the NPO time, the patient can be PO
Diet: Cardiac-Diabetic
Please:
1. IV line fixed
If the patient has a fibrinolytic indication or is unwell, it should be IV x 2. An IV is used only for retplase.
2. Check V/S Q15min until stabilization Q6h or as routine
3. Cardiac monitoring and pulse oximetry
4. O2 Supplement with nasal cannula 3-4 lit/min if Spo2<94% or dyspnea
If there is a need for oxygen therapy of more than 5 liters per minute, a mask should be used, otherwise a cannula is sufficient.
5. ECG
If the patient has ongoing CP: Q20min x 3
If the patient does not have pain: Q6hx2+if pain
6. Check Troponin Q6h×2
It is said that troponin should be checked upon arrival, 3 to 6 hours later, and 9 to 12 hours later.
7. Check CBC-diff_BUN-Cr-Na-K-AST-ALT-PT-PTT-INR-BS glucometry STAT
8. Check FBS-HBA1C-TG-Chol-LDL-HDL-TSH
Tomorrow morning on an empty stomach
9. Serum TNG 5-10 mcg/min if SBP>100 and PR>60
TNG Contraindications:
SBP<90
Sildenafil intake in the last 24 hours
RV-MI
10. Amp M.S 2.5-5 mg IV PRN if SBP>90 and PR>60
Regarding morphine, the use of morphine is contraindicated in cases of RV-MI
If it is necessary to repeat the dose of morphine, morphine can be repeated every 30 minutes.
In cases of RV-MI, fluids can be prescribed to relieve the symptoms of the right side of the heart:
Serum N/S 500 TDS
In cases where it is not possible to prescribe morphine:
10. Amp Pethedine 25mg IV PRN Slow injection
Morphine has 8 times the efficacy of pethidine, and pethidine has more side effects in the elderly.
11. Tab ASA 3x100mg chewable/and 80mg PO Daily
12. Tab Plavix 300 mg PO stat / 75 mg PO Daily
There is no need for loading dose in patients >75 years old.
13. Tab Metoral 12.5-50 mg PO stat / 25mg PO B.D If SBP>90 and PR>60
14. Tab Captopril 25mg PO Stat/ 12.5-25mg PO BD If SBP>100 and K<5.5 In cases of Ant. Aldactone can also be prescribed for MI patients: Tab Aldactone 12.5mg BD if SBP>90 and K<5.5 15. Tab Atorvastatin 80mg PO Stat/40mg PO Daily 16. Amp Heparin 4000-5000 unit IV Stat / 800-1000 unit/hour IV Daily or 16. Amp Enoxaparin 30mg IV Stat/ 1mg/kg S.C BD Start the infusion 15 minutes after the stat dose. There is no need to inject Stat dose in people over 75 years old. 17. Check PTT QID If heparin is prescribed to monitor the patient, PTT should be checked every 6 hours. Our treatment goal is to reach a PTT between 50 and 70. 18. Tab Pantazole 40mg Stat/Daily 19. Syrup MOM 10cc PO TDS 20. Tab Oxazepam 10mg PO QHS Up to item 20, all items are the same for ACS and MI, but the last item should only be prescribed for STEMI: 21. Amp Reteplase 10 units IV stat ×2 Half an hour apart If fibrinolytics are used, an ECG should be taken to check the target of retplase: 22. Check ECG 90min after Retepalse Goal: reducing STE by more than 50% and eliminating CP It is said that it is better to start heparin after both doses of retplase have been administered. 23. Counseling of the honorable uncle of the heart 24. CCU transfers to The patient must stay in the CCU for 24 to 36 hours. #emergency #MI #stroke #heart #order #order #design #elderly_patients #HTN #pressure #CP #shortness of breath #chest_pain #STE #angina This post is written by Phxadmin