arpit
Forum Senior
Topics: 26
Posts: 82
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oxygen
morphine
thombolytics
heparin
b blockers
ace inhibitaors
niitroglycerine
aspirin
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| SA
Forum Elite
Topics: 21
Posts: 193
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I am not satisfied any other try
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| miky
Forum Senior
Topics: 16
Posts: 99
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Put in order
In a patient with acute MI in ED what should be the priority of treatment in following drugs (keep in mind the usmle setting)
1. Oxygen
2. Aspirin
3. Nitroglycerin
4. Morphine
5. Heparin
6. Thrombolytics
7. Beta-adrenergic blockers
8. ACE inhibitors
1st: oxygen
2nd: Nitroglycerin (although not that used)
3rd: Morphine (also if S/S of P.Edema)
4th: Aspirin (if no CI) 1 tb, chewing
The problems come now:
Order an ECHO: calculate the Ejection Fraction
If heart failure - B blockers are counterindicated; give ACE inhibitors
If no heart failure - give B blockers (unless CI) / ACE inhibitors
ACE inhibitors are given regardless of EJf
if <3hrs of onset: give thrombolytics (unless CI)
if > 6 hrs of onset: give Heparin
You must be more specific. There is no strict order, even if you ask us that.
You must consider the clinical status of the pt. How about a painless MI which you dx in the ER?. What if the pt. has cardiogenic shock? What if CI to B blockers? What if CI to ACE inhibitors? What if CI to thrombolytics / Heparin? Pls. be more specific.
Still, I think that O2, Morphine, Nitro and Aspirin should be given to all patients. Of course, if no CI.
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| SA
Forum Elite
Topics: 21
Posts: 193
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Thanks miky
1. I just want to know in a patient with acute MI with no CI of any of following drugs what should I go for next step say if they ask Oxygen had been give what will be next step?
2. Explain
if <3hrs of onset: give thrombolytics (unless CI)
if > 6 hrs of onset: give Heparin
this for me as most of book I seen including Kap show < 12 hours not <3 hours?
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