STEMI

Question 1

SL Nitro

Answer 1

0.4mg x 3 q5min if SBP >90

Question 2

IV nitro

Answer 2

Start at 10mcg/min
Titrate q5min for pain, max 400

Question 3

Pain management

Answer 3

Lower doses in undiagnosed STEMI
so as to not distract from potential changes

Question 4

Morphine for STEMI

Answer 4

2-5mg IV q3-5min to relieve pain. Max 10mg in 30 minutes

Question 5

Fentanyl for STEMI

Answer 5

50mcg IV
May repeat 25-50mcg q3-5 min PRN, max 150 in 30 minutes

Question 6

HTN management in STEMI

Answer 6

> 140 sbp and >90 HR after nitro and pain medication.
Metoprolol 5mg IV
May repeat twice as needed for max of 15mg

Question 7

Anxiety in STEMI

Answer 7

Lorazepam (Ativan) 1 mg IV
i. Repeat q 30 minutes PRN

Midazolam (Versed) 2 – 5 mg IV or IM
i. Repeat q15 – 20 min PRN
ii. Use cautiously in hypotensive, elderly or debilitated patients.
iii. Consider 1mg starting dose.

Question 8

SBP <90 in STEMI

Answer 8

250ml LR bolus. May repeat 3 times if lungs are clear.

Question 9

Hypotension not responsive to fluid bolus in STEMI

Answer 9

Norepinephrine.

Question 10

Heparin

Answer 10

May be administered per local EMS guidelines

AHA Guidelines:
Bolus: 60 units/kg IV (max 4000 units)
Infusion (following bolus): 12 units/kg/hr (max 1000 unit/hr)