What is the significance of a patient being asymptomatic 48 hours (hr) post-admission?

From the Guidelines

For a patient who is 48 hours post-myocardial infarction and asymptomatic, discharge from the hospital may be considered, particularly if the coronary anatomy is unknown and there is minimum myocardial damage, as suggested by the European Society of Cardiology's task force report 1. The patient's asymptomatic status at this timepoint is generally reassuring and suggests a low risk of significant complications. Standard post-myocardial infarction care should continue, including maintaining adequate hydration, taking prescribed medications as directed, such as antiplatelet agents, beta blockers, and statins, and gradually resuming normal activities as previously instructed by the healthcare provider. Vital signs should remain within the patient's baseline parameters, and the patient should be advised to report any new symptoms promptly, including chest pain, shortness of breath, or signs of heart failure. The decision to discharge the patient should be based on the individual's clinical presentation, coronary anatomy, and left ventricular function, as patients with significant left ventricular dysfunction or those who are at risk of new events may require a longer hospitalization 1. It is essential to ensure that the patient has a clear understanding of their discharge instructions, including medication management, follow-up appointments, and signs of complications to watch for. By prioritizing the patient's safety and providing adequate education, the risk of morbidity and mortality can be minimized, and the patient's quality of life can be optimized.

From the Research

Patient Not Symptomatic at 48 Hours

• The patient's condition at 48 hours is not symptomatic, which may indicate that the treatment is effective or that the patient's condition is not severe enough to require immediate attention.
• According to the study 2, paracetamol may be more effective than placebo in relieving pain at 48 hours, with a proportion of children with pain of 10% versus 25%.
• The same study 2 also found that ibuprofen may be more effective than placebo in relieving pain at 48 hours, with a proportion of children with pain of 7% versus 25%.
• However, the evidence is very uncertain about the effects of paracetamol and ibuprofen on fever and adverse events at 48 hours, as well as the effectiveness of ibuprofen versus paracetamol in relieving ear pain at 48 hours.

Treatment Options

• The study 3 suggests that acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain.
• The study 4 found that ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions.
• The study 2 found that paracetamol and ibuprofen as monotherapies may be more effective than placebo in relieving short-term ear pain in children with acute otitis media.

Monitoring Patient Condition

• The study 5 suggests that supportive observations should focus on six factors: agitation, self-harm and suicide, violence, negative influence, disengagement, and positive behavior.
• The Mersey Care Supportive Observations Recording Tool (MSORT) may assist with recording the relevant information during observations.