by BeachGirl08

Hello all. ED nurse with very little experience with post MI care. Family member recently suffered MI while in an ED. Revivied, flown out and treated in cath lab. I have some questions about what to expect recovery wise as well as the care.

After the cath lab (1 stent placed, will need CABG for 2 additional blockages at some point), Artic Sun treatment started. IABP also in place. Fentanyl, ativan, dopamine, heparin running. Cooled for 24 hours/rewarmed for 12+ hours, IABP removed. It took 3 days for her to 'wake' up. On day 4, still very slow to respond, confused, emotional, crying. Docs have indicated a 'sensitivity' to the medications. It is very concerning for the other family members to witness. Do you see this often or is it likely there are neuro deficits due to the arrest/resus? Does identify people, answer simple questions, moves all extremities minimally. Only meds at this time are the beta-blocker, abx (for possible pneumonia) and ativan, as far as I am aware.

If anyone could help us out with what to expect, what is 'normal', what we should be concerned about it would be greatly appreciated. Also be interested in direction to articles, websites etc that would provide good resources for us.
Thank you.
BG

Re: Post MI care and expectations

This person has been through an incredible stress- the neuro effects are mutlifactorial- diffuse anoxia from the arrest, encephalopathy from the cooling, and likely an element of delirium from the narcs and sedatives used during the down time. This stuff takes a while to clear; if there is no glaring focal deficit then the major early risks of CVA have been avoided, and you have to wait for her head to clear. Resolution of the cognitive impairment can take several weeks in some cases.

She should ideally be on plavix +/- ASA and a statin.

Re: Post MI care and expectations

I have some experience with this phenomenon, both with my job and with a family member. Yes, many patients who survive resuscitation come out of it confused, agitated, etc. Besides the things mentioned, reasons can also include poor cardiac output with a "stunned" myocardium, which takes time to recover. My mother-in-law arrested in the field, intubated and resuscitated in the field. She woke up relatively soon, but was very confused, didn't recognize family members, seemed apathetic. Later, when loading her in an ambulance for the ride to a med center for the angiogram, she "woke up" and realized she was being put in an ambulance and wanted to know what was wrong with her. That took about a week before she was herself again.

All I can recommend is continue to re-orient the patient, have patience with their confusion and surround them with familiar things and people.

Just my