Pre hospital approach to STEMI patient and importance of first medical contact

Abstract

INTRODUCTION: Acute myocardial infarction developes after the occlusion of the coronary arteries which leads to irreversible ischemia and ultimate necrosis of the myocardial tissue. This is in contrast to unstable angina which is characterized by reversible ischemia. One of the main characteristics of acute myocardial infarction is functional and organic los of myocardial tissue. CASE REPORT: 50 years old woman called ER at 19:20 due to squeezing chest pain which radiated to the back and which is lasting for several hours. When ER staff arrived on the scene her SBP was 130/80. ECG showed ST segment elevation in II, III, aVF with reciprocal changes in I, aVL. Immediately an IV access is established, nasal canula placed (4Lof O2). She was given NTG spray 0.4 mg x 1and ASA 300 mg. The patient was transported immediately to hospital ( 0.5 km from the scene) while her heart rhythm was being constantly monitored by heart monitor. At the hospital laboratory was done and echocardiogram of the heart. The patient's troponins are elevated and she was transferred to the cath lab. The patient had sleill placed in RCA. CONCLUSION: Definition Acute STEMI, apart from atypical and typical chest pain, requires ST segment elevation in order to be diagnosed. After diagnosis STEMI this requires appropriate urgent treatment with thrombolysis within 12 hours ( the best within one hour if possible) or PCI.

Keywords

• first medical contact
• chest pain
• ambulance