myocardial infarction immediate treatment - MONA -morphine -oxygen -nitroglycerin -asa or plavix myocardial infarction treatment after MONA - angioplasty or CABG pain unrelieved by nitroglycerin - myocardial infarction angina - chest pain stable angi

myocardial infarction immediate treatment - MONA -morphine -oxygen -nitroglycerin -asa or plavix myocardial infarction treatment after MONA - angioplasty or CABG pain unrelieved by nitroglycerin - myocardial infarction angina - chest pain stable angina - -chest pain that occurs when a person is active or under severe stress -T wave inversion on ECG -treatment: rest and nitroglycerin troponin levels - < 0.1 mcg/Ml (as little as 1 hour after occlusion) PT/INR levels - no on warfarin = less or equal to 1.1 on warfarin = 2.0-3.0 PTT levels - not on heparin = 30-40 on heparin = 60-100 CPK - MB levels - 5-25 IU/L what lab is the main indicator for damage to the heart - troponin 1 Hematocrit levels - men: 42%-52% women: 37%48% Hemoglobin levels - Men = 13.5 - 17.5 g/dL Women = 12 - 15.5 g/dL Platelet levels - 150,000 - 450,000 per mcL what can the total CK lab tell you about - muscle damage S/S of ↓ perfusion - Change in LOC Chest Discomfort Hypotension SOB/difficulty breathing Pulmonary congestion/crackles Rapid, slow or weak pulse Dizziness Syncope Fatigue Rapid response team - used for for complications at the hospital pulse sites to check in code blue - carotid or femoral Shockable rhythms - V fib and V tach (pulseless) v tach - Rate: 100-220 beats/min Rhythm: Regular P wave: absent QRS: Wide and bizarre, > 0.12 A run of 3 or more consecutive PVCs (no p wave) treatment for v tach and v fib - With a pulse: (sedate pt first) Synchronized Cardioversion NO pulse (same tx as V-Fib): CPR Defibrillation Epinephrine or Vasopressin Amiodarone (antidysrhythmic) Cardioversion vs Defibrillation - Cardioversion: in sync with QRS, used in AFib, atrial flutter, VT w/ a pulse, SVT Defibrillation: (random shock) - not in sync with QRS, used in VFib and VT without a pulse treatment for new onset A-Fib or A-Flutter w/ rate >180 bpm - cardioversion treatment for long-standing Fib/Flutter - anticoagulation with Heparin drip or warfarin for 6 weeks before cardioversion PR interval norm - 0.12-0.20 secs 3-5 boxes QRS complex norm - 0.06 - 0.12 secs 1 1/2 - 3 boxes indicated by short PR intervals - arrhythmias indicated by long PR intervals - heart blocks or other pathological conditions indicated by ST elevation - myocardial injury (STEMI) STEMI - ST-segment elevation myocardial infarction NSTEMI - non-ST elevation myocardial infarction indicated by abnormal Q wave - myocardial infarction what does a prolonged QT interval put you at risk for - ventricular dysrhythmias and sudden death may be caused by electrolyte imbalance (hypokalemia, hypomagnesemia, hypocalcemia), stroke, hypothermia, or meds Atrial rate - count p waves in 6 seconds and multiply by 10 Ventricular rate - count QRS complexes and multiply by 10 bradycardia treatment - atropine 0.5-1 mg (if atropine doesn't work, due to 3rd degree AV block) temporary pacemaker supraventricular tachycardia (SVT) - hr 160-240 bpm regular rhythm can't measure PR interval, no real p waves SVT treatment - adenosine treat underlying cause P waves in normal sinus rhythm - identical and precede each QRS what electrolyte imbalance in caused by premature ventricular contraction PVC - hypokalemia treatment for a-fib or a-flutter for new onset with rate is <180 bpm - Amiodarone Beta blockers Digoxin Amiodorone - Antidysrhythmic chemical cardioversion Monitor ECG for prolonged QT interval with use of antidysrhythmic 1st degree heart block - This prolongs the PR interval to > 0.20 sec Rate: 60-100 bpm, rhythm is regular This may be temporary due to ischemia Treatment - Observe the patient 3rd degree heart block - aka Complete heart block Tx immediately w/ a pacemaker (any type) V-fib - Rate: Cannot be determined Rhythm: Chaotic P wave: Not identifiable QRS: Not identifiable TREATMENT Assess Femoral or Carotid pulse Call for help or push code button CPR Defibrillation Epinephrine 1 mg Amiodarone 300 mg followed by 150 mg Followed by continuous infusion asystole - do CPR, then give Epinephrine 1 mg every 3-5 min and intubation Pulseless Electrical Activity (PEA) - This is a rhythm on the monitor and no pulse (basically asystole) treatment for PEA - CPR, epinephrine, treat the underlying cause H: hypovolemia, hypoxia, hypothermia, hypo/hyper K+, H+ acidosis T: toxins (overdose), tension pneumothorax, thrombosis (MI or PE), tamponade classic s/s of ACS - Classic s/s Midsternal pressure May radiate to the jaw or down the left arm May be associated with related s/s, such as SOB or fatigue Unstable angina - May see ST elevation but it goes back to normal May occur at rest and require more frequent nitrate therapy Tx: rest + nitroglycerin; drugs affecting platelets Variant = Prinzmetal's (vasospasms) - Can happen at rest or anytime ST ↘ then ↗ during pain episodes ST segment goes back to normal and Nitro won't help Tx: CCB to relax muscles in the vessel treatment for angina - Maintain cardiac output Bed rest Keep pt calm Want a HYPOmetabolic state Pain relief = morphine + nitroglycerin Both have vasodilatory properties Cardiac Bundle, educate pt on: Lipid lowering med - a -statin Beta blockers - Metoprolol Long-acting Nitrates - Isosorbide dinitrate, Isosorbide mononitrate ACE inhibitors - Captopril, Lisinopril, Ramipril Beta1 BlockeRs (-olol) - always check apical heart rate ACE Inhibitors → o p r i l - No NSAIDS No salt substitute or K+ supplements nitroglycerin - Normal adverse effect = patient has a headache Take 1 tablet, call 911 if not relieved, then take 2 more till ambulance comes; don't exceed 3 diagnosing acute MI - unrelieved with nitro Serum troponin I (< 0.1 mcg/L) MI priorities - VS including O2 saturation 12 lead ECG (quickly!) IV access (large bore in a large vein) - 2 IVs if possible Blood sample for labs: CBC, cardiac enzymes and coagulation studies acute mi treatment - MONA Percutaneous transluminal coronary angioplasty (PTCA) - Goal - Increase blood flow to myocardium Balloon catheter is inflated inside the artery Coronary stent may be placed to keep artery open meds post- stemi - Aspirin Clopidogrel indications for CABG - Unstable angina AMI Failure of PCI CABG (Coronary Artery Bypass Graft) - Pre-op teaching Pt can watch educational movie Signed consent Answer questions Post-op teaching Monitor rhythm + hemodynamics Risk of bleeding Risk of hypervolemia Monitor chest tube + mediastinal tube Body temp (they got cold in sx) Pain Management Need to cough + deep breathe Splinting Neurological Pacemaker Issues - Failure to pace: pacer spikes are NOT there Biggest cause = low battery Failure to sense: the pacemaker isn't sensing the pt's HR Can cause ventricular dysrhythmias (mainly V-tach) Treat: change pacemaker's sensitivity setting Failure to capture: not causing contractions teaching for ICD - Keep incision dry for 4 days after insertion or as instructed Report any s/s of infection at incision site or fever immediately It is usually safe to resume sexual activity once incision is healed Avoid Avoid antitheft devices, MRIs, metal detectors, + hand-held screening wands Lifting arm on ICD side above shoulder until approved Avoid driving until cleared by your cardiologist v-tach QRS complex - very wide! a-fib - no p waves, can't count atrial rate, r waves irregular a-flutter - sawtooth appearance of f waves, no p waves, can't count atrial rate, r waves regular