Interview Topics Flashcards
How to manage ptn with STEMI? 12 steps
ECG (done ) +Do Echo ( while preparing PCI ) + Cardiac enzymes
1-O2 if saturation < 90% + Connect monitor + insert IV canulas
2- Aspirin crushed 325mg ( within 30min )
3- Clopedogril 300mg then 75mg maintenance
4- Sublingual Nitrates 10mg
5- B-blockers ( unless contraindicated)
6- Atrovastatin 80mg
7- IV nitroglycerin if needed 5micro/min ( maximum 200mg)
8-IV morphine 2mg ( give 10mg metoclopramide before )
Also helps offload the left ventricle therefore reducing oxygen demand
+/- 9- if ptn develops pulmonary oedema, give IV furosemide
+/- 10- IV Atropine to correct hypotension if present
11- call cardiologists/ transfer to CCU for PCI is the treatment of choice, but it has to be done within the first 3 hours of MI
+/- If PCI can not be done, do Thrombolysis
When PCI should be done VS Thrombolysis in patient with STEMI?
If the patient presents within the first 3 hours after the onset of pain and the procedure can be performed within 90 minutes after initial medical contact, PCI is indicated.
PCI may maintain superior outcomes for even up to 150 minutes
PCI helps 90% of patients, whereas thrombolytic therapy does so in only 50% to 60%
Primary PCI may be preferred in certain patients even after 90 minutes. These include patients with a contraindication to thrombolysis or a high risk of bleeding following thrombolysis; patients with clinical findings suggesting a high likelihood of a complicated medical course or death (i.e. hypotension, pulmonary congestion); and patients with cardiogenic shock.
Thrombolytic therapy ispreferred for patients whose first medical contact occurs less than 3 hours after the onset of symptoms, but for whom PCI is not immediately available; in patients who seek medical attention less than 1 hour after the onset of symptoms (in whom the therapy may abort the infarction); and patients with a history of anaphylaxis due to radiographic contrast material.
The drugs commonly used include streptokinase, urokinase, alteplase, reteplase, tenecteplase and tissue plasminogen activator (tPA).
Combination pharmacological reperfusion therapy with glycoprotein llb/llla Inhibitors (such as abciximab) may also be considered in selected
