Myocardial Infarction

Low complexity — Circulation

Goals

  1. Recognise circulatory compromise in a myocardial infarction and apply nursing interventions.
  2. Name the treatment for a myocardial infarction and its importance.
  3. Recognise and describe the risk factors for a myocardial infarction.

Anamnese

  • Name: Mr Willems
  • Age: 54 years
  • Family: Widower
  • Occupation: Estate agent
  • Cultural: Not known

AMPLE

A: Unknown

M: None

P: Gastritis and alcohol and nicotine abuse

L: 3 hours ago

E: Pain around the sternum, suspected pneumonia

SBAR

S: Mr Willems has just been admitted to your ward. He was referred by the GP after presenting with pain around the sternum. He suspects himself that he has pneumonia. He is now experiencing increasing chest pain.

B: Mr Willems is 54 years old and has a history of gastritis and alcohol and nicotine abuse.

A: See ABCDE

R: Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

A: Clear airway, alert, in pain.

B: RR 23 breaths/min, symmetrical thoracic excursions, normal work of breathing, not using accessory breathing muscles, normal jugular veins, normal breath sounds, saturation 96%.

C: Greyish colour, CRT 2 sec, HR 94 bpm, strong regular pulse, peripherally warm and clammy, BP 152/87, ECG shows early ST elevations in lead II.

D: Alert on AVPU, glucose 6.8, pupils PEARL. Painful sensation in the chest.

E: Temp 36.7°C, no oedema. Urine output: at home 2 hours ago (amount unknown).

Situation at the end of scenario

A: Clear airway, alert, in pain.

B: RR 27 breaths/min, symmetrical thoracic excursions, normal work of breathing, not using accessory breathing muscles, normal jugular veins, normal breath sounds, saturation 93%.

C: Greyish colour, CRT 2 sec, HR 99 bpm, strong regular pulse, peripherally warm and clammy, BP 159/85, ECG shows increasing ST elevations in lead II.

D: Alert on AVPU, glucose 6.8, pupils PEARL. Pressure pain on the chest.

E: Temp 36.8°C, no oedema.

Recommendations

  • Perform ECG
  • Loading dose of acetylsalicylic acid and ticagrelor