09-16-2010, 05:38 PM
step wise,pt with >1 hr chest pain.
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ccs of myocardial infarc - lascrusesdoc
ccs of myocardial infarc - lascrusesdoc
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ccs of myocardial infarc - lascrusesdoc
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09-16-2010, 07:11 PM
oxygen
pulse oxymetry cardiac monitors blood pressure monitors normal saline iv access ecg aspririm morphine nitroglycerine sublingual focal physical ecg------if shows ST elevation start streptokinase cbc esr bmp urinalysis cardiac enzymes 8hourly lipid profile lft pt ptt fobt chest xray admit in ICU-ICU ORDERS cardiology consultation cardiac catheterisation cardiac angioplasty eftifibatide monitor--- If ST Deppression-start patient on haparin monitor PT/PTT eftifibatide lipid profile cardiology consulattion angiography angioplasty Councelling... hey guys let me know if its fine........
09-16-2010, 10:49 PM
why will u do both streptokinase and angioplasty?
09-17-2010, 04:12 AM
Ok i was trying to do some research on this topic
so ER orders - POLICE Pulse ox oxygen inh iv access cardiac monitor BP monitor EKG Morphine nitroglycerine Aspirin EKG -- if NSTEMI --- If STEMI If STEMI - give If with in 90 min then PCI / angioplasty ( priority is PCI --> as it reduces the mortality ) I f > 90 min then go for thrombolytics ( thrombolytics are indicated if the chest pain has been there for > 1 hrs and ST segment elevation in 2 or more leads or New LBBB) thrombolytics should be given with in 30 min of patient's arrival to the ER Make sure you give Beta blocker order lipid profile statins ACE ( points to remember - If asthma - give calcium channel blocker instead of Beta blocker If allergic to aspirin - given clopidogrel instead of aspirin pace maker required - if 3rd degree AV block , Mobitz II , new LBBB, symptomatic bradycardia , If patient with ventricular tachycardia / VF - give amiodarone or lidocaine ) If NSTEMI - No thrombolytic use heparin IV PT / PTT q 6 hrs eptifibatide, tirofiban , abciximab but in NSTEMI only thing which lowers mortality is heparin Source - MTB On last 5 min screen - once pt stable stress test ECHO aspirin clopidogrel Beta blocker statin ace Spironolactone only if EF < 40 NTG prn for chest pain , coumadin - if Af LDL < 70 BP < 140/90 if DM < 130/80 If CKD
09-17-2010, 04:15 AM
CORRECTION
thrombolytics are indicated if the chest pain has been there for
09-17-2010, 04:17 AM
thrombolytics are indicated if the chest pain has been there for
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