MI managment

[wesam]

Management of Acute Myocardial infarction
• Immediate Treatment at home :
1. Analgesia :Diamorphine 2.5 -5 mg I.V.
2. Metoclopramide 10 mg I.V.
3. Oxygen at 5 liter/ min .
4. Bradycardia Atropine 0.6 mg I.V repeated to a maximum of 3mg
5. Lignocaine at 300mg I.M for frequent multifocal Ventricular Premature Beats.
6. Frusemide dose 40- 80mg for heart failure.
• Immediate treatment at hospital :
1.Rapid assessment of ill patient e.g. shock, hypotension signs of LVF or RVF, heart murmurs.
2.Establish I.V access.
3. 12 lead ECG
4. Give:
• Oral Aspirin 150 mg and daily Oxygen 40% .
• Diamorphine 2.5 -5mg I.V
• Metoclopromide 10 mg I.V
• Glyceryl Tri- Nitate Spray x2 if no hypotension; or nitroglycerin 0.3 mg Sub lingual.
1. Thrombolytic therapy:- Streptokinase before administration, Hydrocortisone 100mg I.V and Chorephenaramine 10 mg I.V .
Dose of Streptokinase:-Intravenously 1.5 million units in 100 -200 ml Normal saline over 90 min .
• APSAC ( anisoylated plasminogen streptokinase activator) Dose: is given as 30 units IV over 5 min.
• rTPA ( recombinant tissue Plasminogen activator) Dose: is 80-100mg I.V over 3hr 40mg is given over the 1st hour and 40mg over the next 2 hours.
In CCU consider additional therapy :
1. Beta Blockers: Atenolol 5 mg I.V or metropolis 5 mg I.V Followed by atenolol 5o mg b.d or metropolis 100mg or propranolol 5 mg I.V or tablets.
2. Heparin : Still Controversial .Dose : 5000 units Sub- Cutaneous b.d .or 12.500 units S/C
3. Intravenous nitrates in form of isosorbide dinitrate starting 2 mg I.V / hour Nitroglycerin ( 50 mg ampoule) Add to 490 ml 5% Dextrose ( Concentration 100 mg / ml) start at 10 mg / min increase every 20 -30 min by 20 mg/ min until effect is achieved maximum 200 -700 mg / ml usual range needed is 100 – 300 mg/ min.
4. ACE inhibitors :Captopril starting dose 6.25 mg t.d.s.
5. Magnesium :Dose 8 mmol in 20 ml 5% dextrose over 20 min followed by 65 mmol in 100 ml 5% Dextrose over 24hr.
2. Sedation : Diazepam 5mg oral or Bromozepame 3 mg oral.