myocardial infarction care and treatment

why is early recognition of MI important

• time is muscle

• pts who receive repercussion within the first 3hrs of onset of symptoms had highest degree of myocardial salvage

what is your treatment

• transmit ECG to expert/PPCI for review

• administer aspirin ASAP

• opioids first line analgesics - morphine

• give ondans when giving morphine

• ATMIST pre-alert

what should be done in regards to ECG

• record ECG within 10 mins of initial contact

• repeat ECG if diagnostic uncertainty

• continuous cardiac monitering (ECG every 10 mins)

o2 in MI?

• no high quality evidence suggesting supplemental o2 is harmful or helpful in MI

• hyperoxia may be associated with vasoconstriction and may be harmful in MI

• assess sats and only give o2 in 94% -

how does aspirin work?

• anti platelet action that reduces clot formation

• inhibits platelet aggregation thus limiting thrombus growth

• chewed to increase surface area allowing rapid absorption

dosage of aspirin

• 1 300mg tablet chewed

asprin contraindication

• known allergy/sensitivity

• children under 16

• active GI bleed

• clotting disorders

• severe hepatic failure with jaundice

aspirin indication

• ECG or clinical evidence suggestive of MI

morphine action

• morphine binds to opioid receptors in the CNS

• results in analgesia

• reduced SNS activation

• decreased heart rate and myocardial oxygen demand

morphine contraindication

• respiratory depression 10- reps

• hypotension (90 systlic -)

• head injury with significantly impaired LOC (GCS 9-)

• known hypersensitivity

• children under 1

what are the benefits of morphine

• reduces anxiety and stress

• reduces heart rate, lowering cardiac workload

• reduces sympathetic stress response

• all by reducing severe chest pain

what is the hospital treatment for MI

• primary percutaneous coronary intervention

• catheter inserted through radial or femoral artery and guided to blocked coronary artery

• balloon inflated to open the artery

• metal stent deployed to keep vessel open and allow for normal blood flow

• pt given local anaesthetic

ongoing medical management

• antiplatelet therapy

• anticoagulants

• beta-blockers

• lipid-lowering therapy