Emergency mgt of mi

1. Nursing Management

Myocardial Infarction patient in
Emergency Room
Harmeet Kaur Kang
M.Sc Cardiological / CTVS Nursing
Associate Professor

3. Myocardial Infarction
Myocardial Infarction occurs as a
result of thrombotic occlusion of the
coronary artery and cause
irreversible injury and necrosis.

5. Clinical Manifestations
Chest pain
Severe and prolonged and may be
described as crushing, constricting,
or oppressive.
Radiation of pain to ulner aspect of
left arm, neck, jaw and
Interscapular region.

6. Clinical Manifestations
Contd….
Indigestion
Nausea
Vomiting
Diaphoresis
Palpitations
Dyspnea

7. Nursing Assessment in
Emergency Room
History Taking.
Physical Examination
Vital parameters
12 lead ECG monitoring.
Measure oxygen saturation.
Obtain initial serum cardiac markers.

9. Inferior wall MI: right coronary artery
lead II, III & AVF
Lateral wall MI : Lt circumflex artery
lead I, AVL, V5 & V6
Anterior MI : Lt anterior descending
lead V1 to V6
Posterior Wall MI:Rt coronary artery

10. Immediate General
Management
Oxygen at 4 l/min.
Aspirin 160-325mg.
Nitroglycerine SL or spray.
Morphine IV
Memory Aid: ‘MONA’

11. Nursing management Plan
Chest discomfort R/T imbalance
between myocardial oxygen supply
and demand

12. Goals:
To detect chest discomfort and
associated ECG and hemodynamic
changes early.
To reduce or eliminate chest
discomfort

13. Interventions
Assess and document the chest
pain.
Assess vital parameters.
Obtain 12 lead ECG.
Assess cardiac marker values.
Report the findings of assessment to
physician.

14. Administer oxygen, morphine
sulfate, nitroglycerine or other
medications as ordered.
Provide the restful environment and
promote the patient’s comfort.
Provide care in calm, competent
manner.

15. Decreased myocardial tissue
perfusion R/T an imbalanced oxygen
supply and demand.

16. Assessment
MONA
Start two IV lines.
Early reperfusion:

17. Administer adjunctive medications:
Beta blockers.
Nitroglycerine IV.
Heparin IV

18. No Reperfusion

Delay
NOTE:

19. Time duration
Eligible for
thrombolytic
therapy
Thrombolytic
therapy
contra-
indicated
Not
suitable
for PTCA
Persistent
symptoms
Thrombolysis PTCA
Other medical therapy
No Yes
Reperfusion
>12 hrs<12hrs

20. Administer thrombolytic therapy as
prescribed.
Streptokinase
Urokinase
tPA
Door to drugs: <30min.

21. Prepare for Primary PCI as
prescribed.
Door to balloon 90+ 30 min.

22. Fear/ anxiety related to diagnosis,
treatment and prognosis acute MI
Provide individualized nursing care
in calm and competent manner.
Listen, reflect, guide.