Acute Treatment of ST Elevation Myocardial Infarction (STEMI)

1. Aspirin
a. 150-300mg chewed
b. Then 75-100mg p.o. daily

2. Glyceryl trinitrate
a. 0.3-1.0mg sublingual. Repeat

3. O2
a. 2-4L/min nasal cannula
b. 35-50%

4. Hx and Ex (including risk factors)
a. Cardio history and exam.
b. Resp. History and exam.
c. CVD risk factors

5. Intravenous access and blood tests
a. 2 x 14 G i.v. catheters (orange)
b. FBE, lipids, glucose and biochemistry

6. 12 lead ECG

7. i.v. opiate and an antiemetic
a. Eg. Diamorphine 2.5-5mg (opiate, heroin)
b. Eg. Metoclopramide 10mg (antiemetic)

8. Beta-blocker for ongoing chest pain, hypertension, tachycardia
a. Eg. Atenolol 5mg i.v. repeated after 15mins then 25-50mg p.o. daily
b. Or metoprolol 5mg i.v. repeated to a max. Of 15mg then 25-50mg p.o. BD
c. Avoid in asthma, heart failure, hypotension, bradyarrythmias

9. MOST EFFECTIVE TREATMENT IS PCI (Percutaneous coronary intervention) otherwise give thrombolysis
a. Is preferred treatment within 90 minutes of event
b. Has been proven to be the most effective treatment for 12 or more hours from the onset of symptoms
c. The DANAMI 2 study showed a reduced mortality rate when compared to thrombolytic therapy (8.0% vs. 13.7%)


References
Kumar and Clark pp. 808-816
Rang and Dale’s pp. 597-598, 310-313, 392-393