cardiovascular emergency

Sunanto Ng, MD, PhD cardiologist

aim
15 minute prepare you for the real world
acute myocardial infarction arrhytmia acute heart failure (acute lung edema)

acute myocardial infarction

acute management (ED) reperfusion therapy further management

acute myocardial infarction

acute management (ED):
oxygen (target O2 sat >95%) aspirin 160 mg chew clopidogrel 300 mg nitrat (ISDN 5 mg sublingual) morphine 2 mg

reperfusion therapy further management

acute myocardial infarction

acute management (ED) reperfusion therapy
STEMI : primary PCI or thrombolytic (Streptokinase) NSTEMI/UAP : conservative or PCI

further management

acute myocardial infarction

acute management (ED) reperfusion therapy further management:
antiplatelet (aspirin, clopidogrel) heparin (UFH, Lovenox, Fraxiparine etc) statin (simvastatin, atorvastatin, etc) anti-ischemic (nitrat, beta-blocker) anti-hypertensive anti-diabetic diet

arrhythmia
tachyarryhtmia bradyarrhythmia

bradyarrhythmia

tachyarrhythmia

ACUTE HEART FAILURE IN ED: 2-minutes assessment trick

ACUTE HEART FAILURE the 2-minutes trick

diuretic, NTG

adequate filling, inotropic if needed

Inotrope: dobutamin, low dose dopamin, milrinone

alveoli

LUNG EDEMA
CARDIOGENIC LUNG EDEMA NONCARDIOGENIC LUNG EDEMA

A rapid increase in HYDROSTATIC PRESSURE in the pulmonary capillaries

an increase in the vascular PERMEABILITY of the lung If acute and or severe = ALO

Diagnosis (clinical)
Anxious Pale Tachypnea Confusion Diaphoretic Hypertensive Rales Tachycardia Gallop S3 Pink frothy sputum Wet rales both lung (grok grok)

RESPIRATORY FAILURE : Cyanosis Fatigue Bradycardia Unconcious

Saturation ? Blood gas analysis? Chest X ray? ECG?

1st MANAGEMENT (within 10 min)

1. 2. 3. 4. 5. 6. Fowler position (upright) High flow O2 (NRM) IV access Furosemide 0.5-1 mg/kg Morphine 2 4 mg NTG / Cedocard rapid titration (max dose 200 mcg/min, so be lenient!) 7. Do not DELAY treatment with unnecessary diagnostic!! (incl. Xray, 12 lead ECG, Blood gas analysis)

success!