EMERGENCY MANAGEMENT OF ACUTE STEMI Record weight, vital signs and connect to ECG monitor. ECG to be done within 10 min of arrival - If ECG shows STEMI - We have 2 choices - TNK(Tenecteplase) within 30 min to dissolve the clot or PCI (Per Cutaneous coronary intervention) within 90 min to open the culprit artery. If SpO2 < 90 %, start 2 L Oxygen by a nasal mask. Insert IV cannula in both hands, send blood for Troponin, CKMB, Electrolyte, Lipids, CBC, LFT. Aspirin 100 mg - 2 tablets to be chewed by the patient.
Clopidogrel (Plavix) 300 mg loading dose followed by 75 mg od Bisoprolol (Concor) 2.5 mg or 5 mg stat if no contra indication such as bradycardia, hypotension, heart block in ECG and bronchial asthma. GTN infusion - Indicated if SBP > 90 and ischemic pain persists. Start with 10 ugm /min. ie 2 ampoules (10 mg) in 50 ml of 5 % dextrose and start with 3 ml per hour and…
