Sunday, November 4, 2012

Acute MI

Myocardial Infarction is death of the muscle of the heart. The dead part of the heart's muscle no longer is working, so the heart is not able to pump properly, or in some cases not at all. There are certain medications that we are able to give to our patient's that we suspect are having an Acute MI. These drugs include Oxygen, Aspirin, Nitro, Morphine. Each drug has it's own effects on the body to help prevent the AMI from worsening.

Let's break down each drug:
Information for the drugs listed below are going to be for when use in patient's with AMI only. 
There may be more information related to the drug, but we will only include info for suspected AMI.

     - 2-4 LPM via NC
     - Supplies the heart with oxygen
     - 324mg of chewable baby aspirin (4 tablets)
     - Prevents the formation of clots
     - Contraindication:
         - Allergy to ASA
         - Patient's <12 y/o
     - 0.4mg tablet
          -You can give up to three (3) tablets
     - Causes vasodilation by altering intercellular calcium levels
     - Reduces the preload of the heart
     - Contraindications:
          - Make sure you check the patient's BP before and after each Nitro
               - Do not give Nitro to the patient with a BP <100
          - If you suspect (EKG showing) a Right-sided MI, do not give Nitro
          - Allergy to Nitro
     - 2-5mg IVP than 2 mg every few minutes until pain has subsided
     - Blocks the opiate receptors, causing pain to be relieved
     - Contraindication:
          - Allergy to Morphine
          - Patient's with a BP of <100
          - Patients who are experiencing respiratory depression

Every patient that you suspect of having an AMI, should be treated the same. Always give your patients medications. A simple and easy way to remember the drugs that you can give to a patient that you suspect with an AMI is "MONA." MONA stands for: Morphine, Oxygen, Nitro, Aspirin. Although, the order of the drugs in MONA is not correct, it still helps you with identifying the drugs that are used.

The order for the medications that you give to a patient with a suspect AMI:
1. Oxygen
2. Aspirin
3. Nitro
4. Morphine

Always give oxygen first. Sometimes your patient is just having a cardiac ishemia. Than give your Aspirin, and have them chew them. Obtain BP. If BP is >100 give one 0.4mg of Nitro SL. Obtain BP. Wait 3-5 minutes. If there is no relief, check BP, if >100, give one 0.4mg nitro SL. Wait 3-5 minutes, check BP, if >100, give one 0.4mg Nitro SL. If the patient still has pain, and after the three of Nitro has not helped at all, give Morphine 2-5mg IVP.

It is hoped, that after one 0.4mg of Nitro, the pain will either be decreased or the pain has subsided.

Always make sure to monitor your patients. Be careful when giving any of the medications to your patients. Never hold back on medications. Treat every patient the way you would want your family member to be treated.

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