Podcast
Questions and Answers
What is the initial treatment approach for a patient experiencing an MI?
What is the initial treatment approach for a patient experiencing an MI?
- Follow the MONA +1 protocol (correct)
- Initiate prophylactic NTG administration
- Perform cardiac catheterization immediately
- Administer thrombolytic therapy
In the context of thrombolytic therapy for MI, what is the primary goal?
In the context of thrombolytic therapy for MI, what is the primary goal?
- Destroy thrombus and restore blood flow to the myocardium (correct)
- Increase blood pressure
- Prevent arrhythmias
- Reduce chest pain
What is the significance of troponin release in the context of MI?
What is the significance of troponin release in the context of MI?
- It indicates ischemia
- It causes chest pain
- It leads to an increase in oxygen supply
- It signifies infarction (correct)
In the treatment of pulseless cardiac arrest, what is the critical step to remember?
In the treatment of pulseless cardiac arrest, what is the critical step to remember?
When administering prophylactic NTG prior to exertion, why is it important to carry NTG at all times?
When administering prophylactic NTG prior to exertion, why is it important to carry NTG at all times?
What should be closely monitored when a patient receives thrombolytic therapy for an MI?
What should be closely monitored when a patient receives thrombolytic therapy for an MI?
What is the initial treatment for a patient with a suspected myocardial infarction (MI)?
What is the initial treatment for a patient with a suspected myocardial infarction (MI)?
In the management of pulseless cardiac arrest, what action follows the delivery of a shock if the rhythm is shockable?
In the management of pulseless cardiac arrest, what action follows the delivery of a shock if the rhythm is shockable?
Which electrolyte imbalance is important to monitor when administering diuretics to patients?
Which electrolyte imbalance is important to monitor when administering diuretics to patients?
What are some of the lab values that should be monitored in a patient with a myocardial infarction?
What are some of the lab values that should be monitored in a patient with a myocardial infarction?
What should be considered if a patient presents with persistent asystole during resuscitation?
What should be considered if a patient presents with persistent asystole during resuscitation?
What EKG changes are indicative of an NSTEMI (non-ST segment-Elevation MI)?
What EKG changes are indicative of an NSTEMI (non-ST segment-Elevation MI)?
What is the correct order of administration in the initial treatment for a suspected myocardial infarction (MI) using MONA +1 protocol?
What is the correct order of administration in the initial treatment for a suspected myocardial infarction (MI) using MONA +1 protocol?
Which medication works on the demand of oxygen in a patient with MI?
Which medication works on the demand of oxygen in a patient with MI?
What lab value is considered normal for Troponin in the context of a suspected MI?
What lab value is considered normal for Troponin in the context of a suspected MI?
Which of the following lab values indicates a high risk of bleeding in a patient being considered for thrombolytic therapy?
Which of the following lab values indicates a high risk of bleeding in a patient being considered for thrombolytic therapy?
In pulseless electrical activity (PEA), why does cardiac arrest occur?
In pulseless electrical activity (PEA), why does cardiac arrest occur?
What intervention is necessary for a patient experiencing pulseless electrical activity (PEA)?
What intervention is necessary for a patient experiencing pulseless electrical activity (PEA)?
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Study Notes
Medical Management of Myocardial Infarction (MI)
- Goals of treatment: limit infarct size, pain relief, prevent and manage complications, and preserve myocardial function
- Thrombolytic therapy or Emergent PCI (Percutaneous Coronary Intervention) may be used
- Thrombolytic therapy breaks up clots and restores blood flow to the myocardium
Laboratory Values for MI Diagnosis
- Troponin is the gold standard test for suspected MI
- Normal troponin levels: 0-0.04 ng/mL
- Abnormal troponin levels: >0.2 ng/mL
- Troponin tests should be taken every 6-8 hours, three times
- Other lab values to monitor: potassium (K+) and partial thromboplastin time (PTT)
- Normal K+ levels: 3.5-5.2 mEq/L
- Normal PTT: 25-35 seconds
Pulseless Cardiac Arrest Treatment
- Pulseless electrical activity (PEA) is a condition where the heart stops due to weak electrical activity
- Interventions for PEA include:
- CPR for 2 minutes
- Administer Epinephrine 1mg IV bolus every 3-5 minutes
- Identify and treat the underlying cause (e.g., blood loss, MI, PE, electrolyte imbalance, trauma, toxins)
- Analyze heart rhythm and deliver shock if necessary
- Administer amiodarone or lidocaine as needed
Medication Calculations and Conversions
- 1 kg = 1000 g
- 1 g = 1000 mg
- 1 mg = 1000 mcg
- 1 kg = 2.2 lb
- 1 oz = 30 ml
- 1 cup = 8 oz
- 1 tsp = 5 ml
- 1 tbsp = 15 ml
- 1 tbsp = 3 tsp
- 1 L = 1000 ml
- 1 gallon = 4 qt
- 1 qt = 1 L
- IV Drip Rate Formula: multiply the hour by 60 to get minutes
Electrolyte Imbalances and Diuretics
- Diuretics decrease fluid volume and can cause electrolyte imbalances
- Loop diuretics (non-potassium sparing diuretics) increase excretion of Na, Cl, and K
- Patients taking diuretics may need K+ supplements
EKG Changes in MI
- 12-lead EKG changes are diagnostic for MI
- Changes include Q waves, ST elevation or depression
Patient Education and Medication Administration
- Patients taking sublingual nitroglycerin should be educated on:
- Progression of symptoms to unstable angina
- Taking prophylactic NTG prior to exertion
- Replacing NTG after 6 months
- Keeping NTG in the original bottle
- Feeling a tingling sensation under the tongue
- Repeating NTG every 5 minutes if chest pain persists
- Calling 911 if chest pain is unrelieved
Thrombolytic Therapy
- TPA (tissue plasminogen activator) is administered to destroy thrombus and restore blood flow to the myocardium
- Nursing care:
- Administer TPA ASAP (if no cath lab available)
- Assess for signs of bleeding
- Minimize punctures and invasive procedures
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