Case Study - AMI

You are dispatched to an office building for a 46 y/o M complaining of "chest pain." You ATF a 46 y/o M sitting in his chair, clenching at his chest. He states that his chest pain (CP) start 30 minutes ago, and has progressed. He continues to state that the pain is a 10 out of 10, and describes it as "tightness, pressure, "an elephant is sitting on my chest."

What do you feel is going on? What do you want to do from here (vital wise)? What could be causing the chest pain?

Vitals:
B/P: 152/88                          Pulse: 100                                  Resp: 14
Sugar: 95                              Skin: Pale, Diaphoretic
Pt Position/etc: Sitting in chair, clenching at chest, learning over
Monitor: 12-Lead ECG shows, Sinus with ST Elevation in Leads V3 and V4
Pain Scale: 10 out of 10        Description: Crushing, "an elephant is sitting on my chest"
Time: 30 min ago

Pt Information:
Hx: No medical History                               Meds: Takes a baby ASA once a day (morning)

Now, what do you suspect is going on? What part of the heart is having an infarct?
What comes first, ishemia than infarct or infarct than ishemia? Why? What do each mean?
What is your treatment plan as of right now?
Is this a "load-and-go" or "stay-and-play" patient? Why?

Treatment Plan:
Monitor: Make sure you obtain a 12-lead ECG
Oxygen: Place pt on a NC @ 2 LPM
Medications: ASA 324mg oral, Nitro 0.4mg (every 3-5 min, total of 3 tablets) SL, Morphine 2-5mg IV
IV Therapy: IV of NS at a TKO rate
Monitor: Continue to monitor pt, do another 12-lead after 2 minutes, and continue every 2 min until at
                 hospital
Vitals: Monitor vitals every 2 minutes. Recheck BP before you give another Nitro
Transport: High-priotiy, priority 1 patient, to the closet appropriate facility

Putting it all together:
ABC's; Vitals, oxygen via NC; 12-lead ECG; 324mg ASA establish IV of NS at TKO rate; Nitro 0.4mg SL (do not give for right-side MI), repeat every 3-5 minutes if needed; recheck BP after and before each Nitro given to pt; move pt to ambulance (if not already done); rapid transport to the closest appropriate facility; be prepared for the pt to go into cardiac arrest

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Answers:
1. What do you feel is going on?
           -Possibly heart related emergency; consider an AMI
2. What do you want to do from here (vital wise)?
           -B/P, pulse, resp, skin, monitor (12-lead), pt position and complaints
3. What could be causing the chest pain?
           -AMI

4. Now, what do you suspect is going on? 

           -Pt is having an MI

5. What part of the heart is having an infarct?

           -Anterior, due to the ST elevation in Leads V3 and V4

6. What comes first, ishemia than infarct or infarct than ishemia? Why? What do each mean?

           -Ishemia than infarct

           -You start with lack of oxygen, which leads to a complete loss of oxygen

           -Ishemia is a lack of oxygen to the muscle cells, where infarct is no oxygen to cells, causing 

               cellular death

7. What is your treatment plan as of right now?

            -Oxygen via NC, 324mg of ASA oral, obtain 12-lead again, 0.4mg of Nitro SL, start IV - 

               TKO, Morphine (if needed) 2-5mg IV, high priority transport

8. Is this a "load-and-go" or "stay-and-play" patient? Why?

             -Load-and-go

             -This is because your patient is having an MI. Most procedures can be done while transporting 

                to the hospital, lights and sirens.