Myocardial ischaemia:

 

Goals

·     ↑Supply

·     ↓Demand

·     ±Dissolve thrombus

Investigation

·     ABG (Hb, electrolytes)

·     12 lead ECG

·     Troponin and CK

·     Echo

·     Angiogram

Treatment

Supply-demand:

·     Oxygen

·     Vasopressor

·     Opioid

·     Beta blocker

·     GTN

·     RBC

Anti-thrombotics:

·     Aspirin

·     Heparin

·     Tirofiban

Invasive:

·     PCI

·     CABG

·     IABP (don’t forget!)

 

How to give a sensible amount of GTN:

·        Spray 400mcg

·        Bolus: dilute 1/10 twice -> 50mcg/mL

·        Infusion: 30mg in 50mL -> 10mcg/mL
1mL/h = 10mcg/min