10. A 48-year-old man presents to the ED complaini - highsky

[ArchivalUser]

10. A 48-year-old man presents to the ED complaining
of crushing substernal chest pain. He
is diaphoretic, anxious, and dyspneic. His
pulse is 110/min, blood pressure is 175/112
mm Hg, and respiratory rate is 30/min. His
oxygen saturation is 94%. Aspirin, oxygen, sublingual
nitroglycerin, and morphine are given,
but they do not relieve his pain. ECG shows
ST segment elevation in V2 to V4. The duration
of symptoms is now approximately 30
minutes. What is the most appropriate treatment
for this patient at this time?
(A) Calcium channel blocker
(B) Intravenous angiotensin-converting enzyme
inhibitor
© Intravenous β-blocker
(D) Magnesium sulfate
(E) Tissue plasminogen activator

[ArchivalUser]

ee

[ArchivalUser]

BP 175/112???

[ArchivalUser]

Hmm.BP more than 180/110 is CI. so let's control the BP with iv beta blocker, then go for ee

[ArchivalUser]

10. The correct answer is E. This patient is presenting
with a classic acute myocardial infarction,
and he has fulfilled all indications for fibrinolytic
therapy: acute chest pain suggesting
myocardial infarction, time to therapy less than
12 hours, and ST segment elevation > 2“3 mm
in the chest leads and 1 mm in the limb leads.
Contraindications to fibrinolytic therapy must
still be ruled out.
Answer A is incorrect. Calcium channel
blockers have not been shown to affect mortality
after myocardial infarction and may even be
harmful in some patients.
Answer B is incorrect. Angiotensin-converting
enzyme inhibitors are important once the
patient is stable. They limit infarct expansion
and improve structural remodeling in the days
following an acute myocardial infarction.
Answer C is incorrect. β-Blockers are recommended
to all patients with an ST elevation after
myocardial infarction to decrease myocardial
oxygen consumption and mortality.
Answer D is incorrect. Magnesium is not routinely
used in acute myocardial infarction.

[ArchivalUser]

ANY COMMENTS ON ANS?

[ArchivalUser]

duration 30 mins from index pain .... STEMI ... i would have gone for primary PCI

[ArchivalUser]

thankkk