What are the best diagnostic / therapeutic first steps?
IV, SL ntg , IV beta blocker
IV, CT scan chest , heparin
324mg aspirin (four 81mg chewable tablets), 12-lead EKG, IV access, supplemental oxygen
IV, chest xray, sl NTG, Arterial blood gas
Aspirin 4-81mg, 12 lead ekg, IV, oxygen. Aspirin reduces mortality and morbidity in ACS patients. 12 lead EKG should be performed with 10 minutes of arrival to ED/casualty. IV will facilitate rapid administration of fluids and medications.
IV placed an EKG has been done in Triage.
ST elevation in leads V1-V4 with reciprocal ST depression in inferior (II,III,AVF).
Aspirin, beta blocker if hypertensive, statin Cardiology consult, immediate consideration for thrombolysis or primary percutaneous coronary intervention (PCI).
BP: 150/80 P: 85 R:22 O2: 100% Temp: 36.7
After she is seen by the Surgical resident, she develops hypotension BP 90/50 and an ekg is performed.
ST elevation in leads II,III,AVF, V5,V6ST depression V1-V4.
Avoid nitrates and beta blockers in inferior STEMI because of RV infarction and potential to cause cardiogenic shock.
She now has a palpable pulse but is hypotensive, unresponsive, and hypoxic.
The patient has ventricular tachycardia with a pulse. Defibrillating someone with a pulse is life threatening. Defibrillation delivers electricity immediately whereas during cardioversion, it avoids the vulnerable portion of repolarization and safely delivers a shock to convert to normal sinus.
You re-assess the patient and cannot palpate a pulse.
Once the rhythm is identified as vfib or pulseless vtach, it is imperative to defibrillate as soon as possible to increase chances of survival.
