Myocardial Infarction Flashcards
First ?
Dynamic risk assessment (SMART).
Patient assessment triangle.
Signs and symptoms ?
Pale , grey , ashen appearance.
Shortness of breathe.
Nausea / vomiting.
Clammy / cold to touch.
Diaphoretic = excessive sweating.
Sense of impending doom.
Features of chest pain ?
Tight band around the chest .
Crushing or heavy in nature.
Pain comes on over secs/ mins.
Pain lasting longer than 15 mins with limited / no relief.
Radiating pain :
Pain may radiate into shoulders, arms, jaw and back or epigastric region.
Primary survey (ABCDE) ?
Airway > taking
Breathing > resp rate and sp02.
Circulation > pulse rate , BP, ECG (12 lead )
Disability > GCS, temp, BM.
Examine > make sure patient is as comfortable as possible
History taking ?
Consent from patient.
Presenting complaint
Socrates
Past medical
Family > heart conditions.
Social > smoking, alcohol.
Lifestyle > diet, physical activity.
Observations ?
BP > record stood up and down (repeat every 10 mins ).
Sats > 94% and above ( target)
BM > hypo / hyperglycemia
Temp
4 lead ECG followed by a 12 lead.
Repeat every 10 mins incase a stemi occurs.
Ideally within 10 mins of arrival.
ECG changes ?
STEMI > ST elevation segment suggests MI.
NSTEMI > Non ST elevation MI. ECG may show ST depression, T wave inversion or transient ST elevation.
ECG may also show no changes and may be normal .
Management Medicine ( aspirin ) ?
Admin > oral chewed or dissolved in water.
Dose > 300 milligrams ( 1 tablet )
No repeat dose
Management medicine ( GTN (pain) ?
Admin > sublingual tablet spray ( under tongue)
Dose > 400 micrograms per spray (1-2)
5-10 mins interval no limit .
Oral tablet :
Tablet
600 micrograms. ( repeat dose the same).
5-10 mins before repeat.
Management medicine (entonox) ?
Self administered via face mask or mouth piece.
Takes 3-5 mins to be effective but may take 5-10 mins before maximum effect.
Management medication (oxygen )?
Consider oxygen if sp02 is below 94%.
Measure oxygen sats in all patients.
Moderate levels of oxygen nasal cannulae 2-6 liters per min.
Preference to be face mask as they offer a more flexible dose.
Management ?
If ECG shows ST elevation in 2 or more leads a pre alert needs to be done to PPCI.
And patient will be transported in blue lights (emergency )
Must have ;
2mm ST elevation In chest leads.
1mm ST elevation in limb leads.
Has to be within 1/ hours of symptoms starting .
Further management ?
Position patient for their own comfort.
Reassurance .
Explain what is happening to the patient.
Be honest and compassionate.
Defib pads must be attached when transporting.
Be prepared to begin resuscitation.
Mediation (morphine) ?
Iv - adults over 50kg.
Dose - 10 milligrams (same repeat dose)
Rate of 2 milligrams.
Oral - adults over 50kg
Dose -10-20 g (repeat 20g).
Only consider oral route if Iv isn’t accessible.
