Myocardial Infarction

Mid complexity — Circulation

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Goals

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

Anamnese

  • Name: Mr de Zwart
  • Age: 57 years
  • Family: Married
  • Occupation: Road paver
  • Cultural: Not known

AMPLE

  • A.Tree pollen
  • M.Cetirizine 10 mg once daily
  • P.COPD, claudication and alcohol and nicotine abuse
  • L.Last night
  • E.Stomach complaints, chest pain

SBAR

  • S.Mr de Zwart is admitted to your ward for observation due to a suspected gastrointestinal bleed with stomach complaints. You are now asked to see him because he reports increasing pain.
  • B.Mr de Zwart is 57 years old and has a history of COPD, claudication, 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 24 breaths/min, symmetrical thoracic excursions, normal work of breathing, not using accessory breathing muscles, normal jugular veins, normal breath sounds, saturation 95%.
  • C.Ashen colour, CRT 2 sec, HR 88 bpm, strong regular pulse, peripherally warm and clammy, BP 155/90, ECG shows early ST elevations in lead II.
  • D.Alert on AVPU, glucose 7.7, pupils PEARL. Pressure sensation on the chest.
  • E.Temp 36.8°C, no oedema. Urine output: at home 3 hours ago (amount unknown).

Situation at the end of scenario

  • A.Clear airway, alert, in pain.
  • B.RR 24 breaths/min, symmetrical thoracic excursions, normal work of breathing, not using accessory breathing muscles, normal jugular veins, normal breath sounds, saturation 95%.
  • C.Ashen colour, CRT 2 sec, HR 65 bpm, strong regular pulse, peripherally warm and clammy, BP 142/85, ECG shows increasing ST elevations in lead II.
  • D.Alert on AVPU, glucose 7.7, pupils PEARL. Crushing chest pain.
  • E.Temp 36.8°C, no oedema.

Recommendations

  • Perform ECG
  • Load with aspirin and ticagrelor