Immediate management of Myocardial Infarction.
Reassure the patient.
35% oxygen (unless COAD)
site an IV cannula
take bloods for cardiac enzymes, U and E, FBC and ESR(elevated).
Arrange for continuous ECG monitoring and for CXR.
Diamorphine 5-10mg IV + anti-emetic cyclazine50mg IV for analgesic, anxiolytic, anti-arrhythmic and venodilator effects.
Glyceryl trinitrate 0.5mg SL for coronary artery vasodilatation.
If presentation is less than or ~12hrs after the onset of pain, give
streptokinase 1.5 million units in 100ml 0.9% saline IVI.
Aspirin 160mg/day PO.
Heparin 5000U/ 8h SC until mobilized as prophylaxis against DVT.
If pain continues give isosorbide dinitrate infusion.
Discontinue pre infarction drugs. Prohibit smoking
Continuous ECG monitoring. 24h bed rest.
4 hourly TPR and BP.
Examine Heart, Lungs and legs for complications.
Streptokinase side effects: hypotension and anaphylaxis.
Streptokinase Containdicaions: stoke or active bleeding in the past 2 months, BP more than 200mmHg, surgery or trauma in the past 10 days, bleeding disorders, pregnancy, menstrual period, proliferative Diabetic retinopathy, previous streptokinase treatment in the last 5 days to 1 year.