case study for MI

[momandstudent]

If a patient comes to the Er with a possible MI, why would you insert an IV? I know that I need a hep/saline lock which would constitute one answer but what would another reason be? Would I be right in saying for quick access for med administration such as a bolus? We have not covered this (cardiac) yet and the case study is due next week (along with 2 others, a case study for clinicals, and study guide chaps-sorry for the little rant). I feel so incompetent with this case study and my brain is so overloaded with this and everything else that no matter what I read...it comes up as a "word salad".

[Daytonite, BSN, RN]

This is the medical management of a MI in a nice outline form from the Family Practice Notebook site (http://www.fpnotebook.com/index.htm) (I so love this site and am thrilled it is back up and open to the public again)

• http://www.fpnotebook.com/CV/CAD/ActCrnrySyndrmImdtMngmnt.htm

If you look at the immediate management section, it lists IV morphine for pain. Prior to that, labwork had to be drawn. Things happen very rapidly when someone omes into an ER with complaints of chest pain an is likely to be having an MI. Now, look at this page and the IV medication being given: a heparin drip

• http://www.fpnotebook.com/CV/CAD/MycrdlInfrctnStblztn.htm - Myocardial Infarction Stabilization

One thing I don't see is clot busters which are very commonly given today. When I worked on an IV team we inserted 4 IV sites in people about to receive a clot buster for an MI because once the clot buster (tPA) is given, the patient cannot be stuck again because of potential hemorrhage. The 4 IV sites were for (1) the tPA and the a heparin drip (2) morphine drip for pain (3) access for treatment of any arrhythmias (4) saline lock for blood draws or other IV needs.

Also consider the complications of acute coronary syndrome (the underlying reason of an MI). They are listed on this page:

• http://www.fpnotebook.com/CV/CAD/ActCrnrySyndrm.htm
  • Arrhythmia
    
    • Ventricular Fibrillation
      
    • Accelerated Idioventricular Rhythm
      
    • Bradyarrhythmia
      
    • Atrioventricular Block
      

    [*]Congestive Heart Failure

    [*]Cardiogenic Shock

    [*]Acute Mechanical Complications

    • Ventricular Septal Rupture
      
    • Acute Mitral Regurgitation
      

    [*]Pericarditis

    [*]Ventricular aneurysm

    [*]Recurrent Angina

    [*]Dressler's Syndrome

And, remember, the patient can Code and die at any time. The Swan/Ganz pulmonary catheters that CCU patients have often can have anywhere from 4 to 6 lumens in them for IV infusions of stuff, much of which is incompatible with each other.