STEMI Flashcards
What is involved in the management of a STEMI?
- ECG
- IV access and bloods
- Brief assessment
- Aspirin and ticagrelor
- Morphine
- Consider reperfusion therapy
What bloods should be done in STEMI?
- FBC
- U&Es
- Glucose
- Lipids
- Troponin
What should be included in brief assessment in STEMI?
- History of CVS disease
- Risk factors for IHD
- Pulse, BP, JVP, murmurs, signs of CCF, upper limb pulses
- CXR if won’t delay management
- Contraindications to PCI or fibrinolysis
What dose of aspirin should be given in STEMI?
300mg
What dose of ticagrelor should be given in STEMI?
180mg
If clopidogrel is used instead of ticagrelor, what dose should be used?
300mg
What dose of morphine should be given in STEMI?
5-10mg IV
What should be given with morphine in STEMI?
Metaclopramide 10mg IV
Should GTN be used in STEMI?
Routine use not recommended in acute setting unless patient is hypertensive or in acute LVF
When should oxygen be used in STEMI?
- Sats <95%
- Breathless
- Acute LVF
What are the ECG criteria for reperfusion therapy?
One of;
- ST elevation >1mm in 2+ adjacent leads, or >2mm in 2+ adjacent leads
- LBBB
- Posterior changes (deep ST depression and tall R waves in leads V1-3)
What are the options for reperfusion therapy in STEMI?
- Primary PCI
- Thrombolysis
Who should be offered primary PCI in STEMI?
Patients presenting within 12 hours of symptom onset, who are either at or can be transferred to a primary PCI centre within 120 mins of first medical contact.
When should primary PCI be used beyond 12 hours of symptom onset?
Evidence of ongoing ischaemia or in stable patients presenting after 12-24 hours - seek specialist advice
What is the target time for thrombolysis?
Within 30 min from admission
When does the use of thrombolysis require specialist advice?
> 12 hours from symptom onset
What agent is used for thrombolysis in STEMI?
Tenecteplase
What are the contraindications to thrombolysis?
- Previous intracranial haemorrhage
- Ischaemic stroke <6 months
- Cerebral malignancy or AVM
- Recent major trauma/surgery/head injury (<3 weeks)
- GI bleeding in last month
- Known bleeding disorder
- Aortic dissection
- Non-compressible punctures <24hours, e.g. liver biopsy. LP
What are the relative contraindications to thrombolysis?
- TIA <6 months
- Anticoagulant therapy
- Pregnancy/ >1week post-partum
- Refractory hypertension
- Advanced liver disease
- Infective endocarditis
- Active peptic ulcer
- Prolonged/traumatic resuscitation
What should happen if thrombolysis?
Patients should be transferred to primary PCI centre for rescue PCI (if residual ST elevation) or angiography (if successful)
What should be done in patients with STEMI who do not receive reperfusion therapy?
Treated with fondaparinux
