MYOCARDIAL INFARCTION TREATMENT STEMI

STEMI is one of the diseasees most often presented at the ER. And since we or our relatives may experience an episode of acute coronary disease it is very important to know what to do at first. And for those who are doctors knowing this more than a must :P This medical treatment is easily performed so  everybody should know it.

Aspirin 150mg is essential in acute coronary syndrome. It’s function is  to prevent txa2 and type I cyclooccygenasis from production resulting in vasodilatation and prohibition of thrombus formation.  Within minutes, aspirin prevents additional platelet activation and interferes with platelet adhesion and cohesion. It is given oraly in capsules from 160-325 mg.

Nitroglycerina 2.5-6.5mg should be given in a period of time every 5 minutes. It  is given sublingual to  manage the chest pain by lowering the need of the miocard for O2 and by raising myocard performance. If not resulting in managing the situation than consider giving them iv. Should not be giving it to a person who has low BP, or has taken phosphodiesterase inhibitors in the last 24 hours. Izosorbit dinitrati 5mg sublingual cdo 5-10 min deri ne max 5 tableta .

Morphin  5mg wasted in sol NACL 0.9% .  it is used as an analgesic to  treat the chest pain. Pay attention with the venous pooling since it may lower the cardiac output. Be aware that it can cause hypotension and different degrees of heart bloc which can be treated with atropine. (0.5mg iv). Morphine is given  every two minutes to receive a better  absorption.

Oxygen 40% -> it is indicated when the patient is experiencing hypoxemia and should be given for6- 12 hours after infarction.  

IV BETABLOCKERS were proven adequate to manage chest pain and to reduce the risk of reinfarction or ventricular fibrilation. They  should be started within 24 hours from the infarction and the patient should not have signs of heart failure. Caution-> It  increases the risk of cardiogenic shock, lowers cardiac output. METOPROLOL 5mg every 2-3 minutes for three times.

It is a critically important treatment but then further analysis and interventions can and should be made to totally treat the problem :such as fybrinolysis, reperfusion,percutaneus coronary reperfusion.

HIGH TEMPERATURES AND WHAT WE SHOULD KNOW

High temperatures have become a main public health problem these summer days because they have caused several deaths and worsened the health of many citizens. Gradually the body adapts the new conditions being so acclimatized.  It is important to know somethings such as 1. The right measures to take in order to cope with  heat the right way 2. Who is considered at higher risk 3. What are the most usual medical problems from the heat and how are they treated.  Otherwise the high temperatures may affect main functions of the body in a range from mild problems to serious ones.

1.       What we should do?
Stay as away as you can from hot weather.
• Close the windows and curtains when it is hotter outside to prevent the heat and the daylight from coming inside the house.
 • Stay in an air conditioned room with a normal room temperature (not very low since the temperature gap  is very bad.• Electric fans are also useful
.• Try not to cook inside.
 •If your car has been left not in the shades let the hot air inside cool down before you start driving. Use reflective sunshades in the car.
•It is also recommended to place a cooling compress on your wrist of 30 seconds to cool the blood and provide a instant relief .
•Avoid going out at midday if not always with a bottle of water, a hat, suncream to protect your skin, loose clother, lightened colors. Stay in the shades
Hydrate-> since we lose a lot of water by sweating we need to replace it and this is essential to normal functions of our body. It is important to drink 2-3l of liquids. Cold Water is always a first choice. Fruit juices are also a good choice since we also take different kind of vitamins. Yougurt  also.
•Foods help us hydrate. The ones high water containing are Fruits and salads.Spicy food also help you because they cause your body to sweat so we cool off naturally.
•Avoid caffeine and alcohol since they incresase perspiration and they are dehydrating.

2.       Groups at higher risk.
•Infants til 4 years old. they are more sensitive to the effects of high temperatures and as rely on others to regulate their inner environment and to provide adequate fluid intake. They have a higher metabolic rate and inefficient sweating compared to adults.
•People 65 years of age or older may not be able to precisely regulate their inner temperature since they central nervous system is not fully competent. Also other heat loss mechanisms may not be adequate because of the chronical diseases witch pre existe in these patients.(cardiovascular and respiratory which can cause dehydration easily) and also elderly people (everybody who takes these pills) take several  kind of medicines such as vasoconstrictors, diuretics, antidepressants•Overweight individuals may be prone to heat-related illness because of their tendency to retain more body heat. 

Heat related illnesses HRI

->HEAT CRAMPS. This is the last serious form of HRI and it is charactarised with intermittent large muscle spams(usually the ones which were included in the activity) and significant sweating. They usually happen to people who do physical acticity in the sun.they do not happen during the activity but after.(hot environment). They can be treated with rest, cooling the body, rehydrating, take some salt to replace the electrolytes. If there is muscle pain after the episode than nsai pill can be used.

->HEAT RASH. It happens when the skin sweat glands are blocked and the sweat can not get out so the gland gets inflamed which is presented as rash. The skin  appears with tinny red bumps with the sensation of itchy and prickly ,due to inflammation of the superficial layers of the skin. It happens in the areas where there isn’t much air circulation usually due to tight clothing, heavy creams so the sweat is not allowed to evaporate.(attentions heat rash can also happen from the use of clonidine)
It Is treated by removing its cause as tight clothes and trying to expose the skin to well ventelated areas. Dusting powder can be used since it does not cover the sweats. It usually does not require medical care.

->HEAT EXHAUSTION.  It is a condition that happens when a person looses to much water and electrolytes since he is not acclimatized to staying or working in such hot weather. So the normal mechanisms will not be stabilized resulting in several symptoms such as excessive sweating, nausea,elevated body temperature ,pallor, confusion, tachycardia, tachypnea,headache, fatigue, weakness,muscle cramps, wet skin.
There are two types, the one from loss of water and the other from loss of electrolytes. in the first one there is hypernatriemia present and there isn’t to much sweating. The person feels thirsty and doesn’t urinate much. The BP is lower than usual.
The other is from loss of the electrolytes and is represented especially with hyponatriemia
Noramly this condition does not require medical care but we should do things such as drink plenty of water and eat salty snacks, rest in an air conditioned room and take a  cool shower. Unless treated right this may progress  towards heat strike which is the most serious HRI's

->HEAT STIKE. it is a situation in which the body's ability to lose heat is lost so the body temperature is raised critically(+41c). it is considered a medical emergencie since it leads to death and severe systemic disabilities. They depend on the max temperature and the duration of heat strike. Two types of this.1EHS which occurs in young and healthy people due to physical activity in a hot area. 2.NEHS it happens to elderly , very young or chronically ill (cardiovascular or respiratory).

High body temperature, dry skin, red skin color,difficulty breathing, tachycardia, headache, dizziness, disorientation, nausea, vomiting,seizures, coma.CALL THE EMERGENCY SERVICE. rap a person with cool stuff, or place a fan in front of him, place ice pack in the arms,neck. If possible place the patient a cold bath-tub. Monitor the body temperature and give the person cold drinks if he is conscious.(the target is at least39C). control and try to restabilise the electrolytes. If the seizures begin take care of the respiratory airways, blood cirvulation. (ABC).