Management for AMI patient

[datamini]

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!

[Daytonite, BSN, RN]

http://www.emedicinehealth.com/heart_attack/article_em.htm - heart attack

http://www.guideline.gov/summary/summary.aspx?doc_id=11333&nbr=005906&string=myocardial+and+infarction - acc/aha 2007 guidelines for the management of patients with unstable angina/non st-elevation myocardial infarction

[datamini]

Thanks.. but i still need more help.. anyone have any more good website? cos i still don't understand whether or not i need to give IV nitroglycerin or IV morphine. then do i need to give aspirin? if yes, when do i give? Oo...o.. this is so complicated..!!

[nsgstudent007]

I have always been taught to use the acronym M.O.N.A. for management of Acute Myocardial Infarctions.

M- Morphine

O- Oxygen

N- Nitroglycerine

A- Aspirin 80 mg for preventative anticoagulant effect.

[SuperSleeper]

confirmed AMI = ASA 325mg, not 80 UNLESS pt has a confirmed clotting disorder or hx of GI bleed.

81mg is indicated for post MI maintenance after approx 1-2 weeks of 325mg. Some docs even go as long as a month. Otherwise it is used prophylactically BEFORE pt ever has an MI.

SS - RN, CCRN, SRNA

[datamini]

I just found out frm my lecturer that there is no need to give nitroglycerin, but need to give morphine and aspirin.. anyway.. i'll still try to research on it.. anyone with more information?

[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.

SS

[leslie :-D]

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.

SS

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?

leslie

eta: unless this is pre-hospital mgmt, then ntg would be given.

if pain persisted, then ms04.