Management of Emergencies

Question 1

Management of ACS - STEMI?

Answer 1

1. 12 lead ECG
2. IV access - bloods (FBC, U&E, glucose, lipids, cardiac enzymes)
3. Assessment
   - Hx: CVD, IHD
   - O/E: pulses (inc upper limbs), BP (both arms), murmurs, JVP, Sx CCF, scars from prev surgery
4. Aspirin 300mg (unless already given by GP/paramedics)
5. Morphine 5-10mg IV
   + anti-emetic, e.g. metoclopramide 10mg IV
6. If STEMI on ECG and PCI available in <120 mins: PCI
   If not available: Fibrinolysis + transfer to PCI centre if unsuccessful

Question 2

What dose of aspirin is given in STEMI?

Answer 2

300mg

Question 3

What dose of morphine is given in STEMI?

Answer 3

5-10mg IV

Question 4

What is given with morphine in STEMI?

Answer 4

Anti-emetic, e.g. metoclopramide

Question 5

What is the gold-standard treatment for STEMI?

Answer 5

Percutaneous coronary intervention (PCI)