Pt with mi

Evolving MI is an immediate ticket to the ICU, if there is no cath lab.

At my hospital, a pt that is having an MI is transferred to ICU for close and careful monitoring. With an MI, a part of the heart is dying and therefore it is alot easier for a pt to code,ect. Most of our pt's usually go to the cath lab and then to the unit. However, if immediate cath is not possible, then we usually will start the pt on Integrillin to decrease platelet aggregation or Retavase which helps to break up the clot. These are both very powerful blood thinners so it is important to make sure that the pt has no active bleeding or recent surgeries before beginning these medications. The pt is also given 325mg ASA, Lopressor 5mg x 3 doses and Nitro gtt.The Nitro dilates the vessels and reduces the workload of the heart. Lopressor is given b/c it helps to control the heart rate as well as effects the workload of the heart. Lopressor has also been shown to reduce future MI's and to help prevent post MI heart failure. Morphine can also be given to help with pain and anxiety. Just remember MONA: Morphine, Oxygen, Nitro, Asprin! Hope this helps!

Unless proven negatine by enzymes our patients with probable MI symptoms are supposed to go to CCU-with unstable VS/drips or PCU-stable VS/no drips until definitive care is done- cath lab, angio, stints.. Drug reperfusion therapy (rTPA) is always CCU. Positive enzymes are in ccu/pcu until a return to normal values.

As they say in Monopoly - Go straight to the cath lab ... do not pass go ... do not collect $200.00 ... Our ER door to first balloon inflation goal time is under 52 minutes.

Your Community Chest card will then state "Time = lost heart muscle" and send you for a visit to CICU. You are totally correct on your suggestion that the patient belongs in ICU/CICU. Good for you!

In your hospital would a pt who is in the process of having an MI be on a tele floor or in the ICU? I'm just curious. Obviously I had a disagreement with the cardiologist at work today regarding this. Also when a pt is put on a nitro gtt is it for symptomatic cp only?

Some background on pt --> bp 180s/90s, asymptomatic cp at present time -was symptomatic at home and popping nitro like candy, troponin almost 20. I felt with his bp he could tolerate nitro but the cardiologist was not returning my call so I called the primary doc and the first thing she said was transfer pt to the icu.

We generally don't get pts with an elevated troponin unless it's been higher and is coming down and has had an intervention done.

With a troponin of almost 20, why wasn't he in the cath lab already!

Telemetry will take NSTEMI's, USA, ACS III, and ACS II. we do take nitro gtt's up to 10 mcg/min. if troponin bumps greater than 0.40 we will have heparin and integrelin started, if troponin keeps bumping and pt stays symptomatic, or has new ST changes or q waves he's going to cath lab.

Yep, a patient like that would go directly to the cath lab. They would come to us after.

Thanks to everyone for your responses. The cardiologist who was rounding gave me attitude because I transferred the pt to the ICU. He was miffed at me for that and said is this not a heart tele unit? He has been known to be extremely arrogant to the nurses. I felt like I was doing the right thing and the other cardiologist in his group knew I was going over there (ICU) with the patient and told me he was done rounding over there but that he would meet me over there to see the pt. He had no problem with the patient going there. By the way they didn't do a cath on him and his INR was 4.5 when he came in. Yesterday it was over 5 and they never ordered any vit k for him either. I just felt like this pt could become unstable at any time.

Interesting that they didn't cath the pt. I work on a telemetry step down unit and we normally don't send pts like that to the unit. They stay on our floor and since I work nights it's rare that a cardiologist would come in to do a cath unless a pts troponin is really high. I've actually only ever seen one pt go to cath lab emergently overnight and they ended up dying on the table.

As for the nitro gtt, we sometimes even put pts on them for high blood pressure although I tend to find it's not really effective. Normally we only keep the nitro gtt on if the pt is having cp unless the cardiologist orders us to keep it on.

Why wouldn't a patient go to the cath. lab in the middle of the night? Every time I am on full weekend call the chances are we will come in at least once in the middle of the night. On average we get called in about 4 times a weekend and once I was in there knee deep in acute STEMI's for 44 of the 48 hours. Thank goodness that doesn't happen too often. To get our "ER admission to first balloon inflation" time down they call us in sometimes based on the transporting Paramedics interpretation of the patient being a STEMI ... and you best just stop, drop and roll your butt in there ASAP or my boss knows why on Monday morning. Love her but wouldn't want to be late to a STEMI.