From the Guidelines
In emergency medical situations, the immediate steps for impending treatment should follow the ABCDE approach, prioritizing airway, breathing, and circulation, while also considering the specific needs of patients with suspected acute myocardial infarction (MI), such as oxygen, aspirin, and nitroglycerin administration, as well as prompt acquisition of a 12-lead electrocardiogram (ECG) to guide reperfusion therapy 1.
Initial Assessment and Management
The initial evaluation of the patient should be accomplished within 10 minutes of arrival in the emergency department, with a focus on:
- Ensuring a patent airway and providing oxygen by nasal prongs
- Assessing breathing and providing rescue breaths or bag-valve-mask ventilation with supplemental oxygen as needed
- Evaluating circulation and controlling any visible bleeding with direct pressure
- Administering aspirin, 160 to 325 mg orally, and sublingual nitroglycerin, unless contraindicated
- Acquiring a 12-lead ECG to guide reperfusion therapy
Reperfusion Therapy
For patients with ST-segment elevation myocardial infarction (STEMI), reperfusion therapy should be initiated promptly, with a goal of minimizing door-to-balloon time, and considering the use of thrombolytic therapy or primary percutaneous coronary intervention (PCI) 1.
- Thrombolytic therapy should be administered within 6 hours of symptom onset, with the greatest benefit occurring when initiated within 1 hour
- Primary PCI may be performed as an alternative to thrombolytic therapy, provided that it can be accomplished in a timely fashion by skilled personnel
Prehospital Care
Prehospital care should prioritize the acquisition of a 12-lead ECG, as well as the administration of oxygen, aspirin, and nitroglycerin, and the initiation of treatment with morphine and insertion of an intravenous line 1.
- The prehospital ECG should be communicated to the destination hospital to facilitate prompt reperfusion therapy and minimize door-to-balloon time
Hospital Management
Hospital management should prioritize the efficient evaluation and treatment of patients with suspected acute MI, with a focus on:
- Streamlining the evaluation process by having a physician and necessary resources ready before patient arrival
- Minimizing physical movement and transferring between stretchers
- Activating the catheterization laboratory while the patient is en route, or bypassing the emergency department and transporting the patient directly to the catheterization laboratory, if possible.
From the FDA Drug Label
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From the Research
Immediate Steps for Impending Treatment
In emergency medical situations, such as myocardial infarction (MI), immediate treatment is crucial to prevent further damage and improve patient outcomes. The following steps are recommended:
- Administer aspirin to prevent blood clotting 2, 3
- Provide oxygen to increase oxygen supply to the heart 2, 4
- Use nitroglycerin to treat chest pain and improve blood flow to the heart 2, 4, 5
- Administer painkillers, such as morphine, to relieve pain 2, 3, 4
- Consider using beta-blockers, ACE inhibitors, or calcium channel blockers to lower blood pressure and improve heart function 2, 3, 4
Diagnostic Tests
Diagnostic tests, such as electrocardiogram (ECG), coronary angiography, and X-ray, can be performed to assess the extent of heart damage and guide treatment decisions 2, 3, 4
Treatment Options
Treatment options for MI include:
- Thrombolytic therapy to dissolve blood clots 2, 3, 6
- Percutaneous coronary intervention (PCI) with stent placement to restore blood flow to the heart 3, 6
- Coronary artery bypass grafting (CABG) to bypass blocked arteries 3, 4
- Medications, such as statins, to lower cholesterol and prevent further heart damage 3