- See: blunt cardiac trauma
- Initial Management:
- determine whether the chest pain is of cardiac origin:
- sublingual nitroglycerin should improve chest pain (at least partial relief) if the pain is of cardiac origin;
- EKG changes in MI:
- labs: CBC, cardiac enzymes (CPK q6 hours x 4 or cardiac troponin T & I);
- optimize cardiovascular function:
- nitrates can be given sublingually or topically before intravenous access is obtained;
- arrhythmia
- hypertension:
- elevation of blood pressure should be managed with combination of nitrates, beta blockers (antihypertensive agents), and morphine;
- nitrates are the treatment of choice in patients who have hypertension with angina or myocardial infarction;
- beta-blocker therapy given IV at admission, reduces mortality & infarct size and is recommended;
- IV labetalol and calcium-channel antagonists also reduce blood pressure while improving myocardial oxygenation.
- hypoxia: w/ decrease O2 sats, order ABG, and give O2;
- anemia: pRBC transfusion
- monitoring: patient should be placed on a telemetry bed if one is available;
- blood thinners and thrombolytics:
- begin thrombolytic therapy in combination with aspirin and heparin;
- Outside Links:
- GMO Manual
- GMO Manual
- Iowa Family Practice Handbook - 1
- Iowa Family Practice Handbook - 2
- Merck Manual
- GMO Manual
- Iowa Family Practice Handbook - 1
- Iowa Family Practice Handbook - 2
- Merck Manual
- References: