I need to do a presentation for my schoolwork on immediate management (first 4 hrs) of AMI (acute myocardial infarction) patient. These are what I've prepared, is there anything to add on or any correction? Thanks for your help!
1. Relief chest pain
- Assess for verbal and nonverbal signs of pain. Document pain score and characteristics of pain.
- Give oxygen therapy to decrease ischaemia and pain.
- Promote rest to decrease cardiac workload and decrease sympathetic nervous system stimulation, and promote comfort.
- Give IV morphine 2-4mg
The case is that patient's BP is 90/60, so is it right that i don't give IV nitroglycerin? Then that's why i give IV morphine instead. But i see in wikipedia, morphine can also cause hypotension. So how?
I haven't study this topic, so this is what i know at the moment from my research. Need help!
Jun 2, '08
Quote from SuperSleeper
Interesting. Did your lecturer give a rationale for not giving the ntg? I would love to hear it. The reason for giving it is to dilate the coronary vessels to allow flow around/through a blockage (clot/stenosis). Granted, if the BP is low it is not recommended given its ability to bring it lower. However, nitrates are generally used to buy time AND to help r/o MI.
the only way we know if ntg is effective, is by pt's resolution of angina.
so why give it if morphine will be addressing the pain?
eta: unless this is pre-hospital mgmt, then ntg would be given.
if pain persisted, then ms04.
Last edit by leslie :-D on Jun 2, '08
: Reason: afterthought