Oh Another Nasty Mi
Oxygen
Aspirin
Nitrogen
Morphine
When acute MI is suspected…
- 911
- 12 lead ECG (in under ten min)
- obtain diagnostics
- medical intervention
- evaluate for re perfusion
- continue med intervention as indicated
Define acute coronary syndrome
Prolonged, untreated ischemia leading to:
- unstable angina
- MI
- Non ST Elevation (NSTEMI)
- ST-segment elevation (STEMI)
Define unstable angina
- change in usual angina
- new onset
- occurs at rest
- worsens
- caused by reduced blood flow In a Corinary artery, often due to rupture of Corinary plaque,
-clot does NOT COMPLETELY OCCLUDE
THIS IS AN EMERGENT SITUATION
Myocardial Infarction (MI)
- sustained ischemia over twenty (20) minutes
- ischemia and necrosis
- caused by plaque rupture and thrombus formation
- COMPLETE OCCLUSION
Necrosis of the entire thickness of the myocardium takes how long?
4-6 hours
Most MIs involve which ventricle, and which artery?
-left ventricle, and left anterior descending coronary artery
When assessing a pt with suspected MI, you would expect what clinical findings?
- severe pain that does not improve (crushing, constricting, burning)
- substernal, retrosternal, epigastric, radiating to neck, jaw, arms
-Sympathetic response- vasoconstriction of peripheral blood vessels sweaty, cool clammy skin N/V -crackles -increased HR and BP at first, then decreased BP -JVD -fever - heart sounds: s3,s4,murmur -Fever
Most common complication of MI
Dysrhythmia
- 80%
- most common cause of death in prehospital period
- anterior MI, heart failure, shock
Complication of MI
- Dysrhythmia
- Cardiogenic shock
- Papillary muscle dysfunction
- Ventricular aneurysm
- Acute pericarditis
Depolarization
Contraction
Repolarization
Relaxation
EKG placement
White is right, and over green
Black is left, and over red- smoke over fire
Hot carl- brown to chest
PR interval
0.12-0.20
QRS
under 0.10
Little box
.04 seconds
P-Wave
Atrial depolarization
SA node fire
