Myocardial Infarction (MI,Heart Attack) Treatment in Emergency | Step wise STEMI Management USMLE
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- Опубликовано: 4 дек 2020
- Myocardial Infarction (MI,Heart Attack) Treatment in Emergency | Step wise STEMI Management USMLE
myocardial infarction emergency treatment and management is highly tested topic on usmle step 2 ck.STEMI heart attack inferior wall mi management in emergency department is found quite challenging by many students across the globe. this video gives you a step wise approach to mi treatment in emergency . stemi myocardial infarction treatment guidelines are updated quite oftenly but the basic management has always been the same. emergency heart attack management .heart attack(myocardial infarction) signs and symptoms are also explained in this video by a case description in the very beginning.
nitial medical therapy during STEMI consists of oxygen administration, antiplatelet therapy (aspirin, thienopyridines and glycoprotein IIb/IIIa inhibitors), anticoagulation (heparin or bivalirudin), anginal pain relief with nitrates and morphine, and beta-blockade. Medical therapy upon hospital discharge may include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists and HMG CoA reductase inhibitors.
Aspirin: Aspirin should be chewed at a dose of 162 to 325 mg immediately once STEMI is diagnosed unless a contraindication exists. Lifelong therapy using 75-162 mg daily should follow upon hospital discharge.
Thienopyridines: P2Y212 receptor antagonists (clopidogrel, prasugrel, ticagrelor, and ticlopidine) are indicated in all STEMI cases unless surgery is needed. Clopidogrel can also be used as an adjunct to fibrinolytic therapy in patients intolerant to aspirin. If coronary artery bypass grafting is required, these agents should not be used. These agents must be discontinued for 5-7 days prior to CABG unless urgent and the bleeding risk is less than the benefit of revascularization. Regardless of the type of stent used during PCI, thienopyridines are preferred to be continued for 12 months if possible. Prasugrel is not recommended in a patient with a prior history of stroke or TIA. Ticlopidine is rarely used due to the risk of thrombocytopenia and TTP (thrombotic thrombocytopenic purpura).
Glycoprotein IIb/IIIa inhibitors: These drugs include abciximab, eptifibatide, and tirofiban. They very strongly inhibit platelet function by blocking the binding of fibrinogen to the activated glycoprotein IIb/IIIa receptor complex. Any of these agents may be used in addition to aspirin, a thienopyridine and anticoagulation (except with bivalirudin) at the time of PCI in high risk patients with STEMI. Using glycoprotein IIb/IIIa inhibitors prior to PCI does not have strong data to support its use at the present time.
Anticoagulation: Full anticoagulation should be started in all STEMI patients unless a contraindication exists. Either unfractionated heparin, low molecular weight heparin (enoxaparin or fondaparinux) or bivalirudin can be used. Unfractionated heparin for 48 hours total and low molecular weight heparin for 8 days or until hospital discharge.
Nitrates: Nitrates are helpful to treat angina symptoms, hypertension and heart failure during STEMI, however no clinical data exists to show a mortality benefit and thus their use is individualized. The use of nitrates should not preclude using drugs that do show a mortality benefit.
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Sir you are best teacher for us
Sir, good morning. A quick question; does the vasodilators like GTN dilate only specific type of blood vessels or it dialtes the whole circulatory system?
My one stop channel before hospital interviews.... U r lifesaver not only to patients but also for medics like me 🙏🏻🙏🏻
Thank you Yashwanth for your kind words. 😊
I have searched through a lot of videos but the moment I came across urs I knew this was what I needed all along. Very clear easy to follow step by step management. Thank you
Thank you Aminath Shifana! I am glad to hear that. 😊
Please mention drug doses too
Haven’t found any Heart failure discussion so precise and up to date. Very very helpful
I like how you explained everything instead of just blurting out a bunch of stuff. Thank you
The best video ever! you simply wrapped up everything very perfectly! YOU ARE THE BEST!!!
I don’t know how to thank you enough I have been looking for treatment of mi in brief way for a long time thank you so sooooo much ❤️
I am very glad you found it helpful. 😊 Thank you for your kind words
I am very glad you found it helpful. 😊 Thank you for your kind words
A concise discussion on MI.Thank you so much sir.
You made my years, really what a clear nice way ..
words well spoken knowledge well delivered, I can’t thank you enough.
I am very glad that you found my video helpful. 😊
Keep posting this kind of informative video. Thanks
Many doubts get cleared,thank you sir😊
very useful and simple thank you so much Doc !
Your video are the tremendous source of knowledge. I do love it. Loves from Cambodia ❤❤❤
Thank you so much for sharing your knowledge with us ICU RNS,you make it so easy to understand and very informative!
One of the best and precise in alucid style.Great Lecture
The chapter that took 2 hours to read is explained here in few minutes video. Thank you Sir❤
That's so brilliantly explained
May Allah bless you.
8 hours of lecture explained in less than 12 min! 👈🏻👏👏
Excellent. Thank you, Doctor.
Best learning vedio ever.. Explained everything clearly and in a simplified way…
Crystal clear, thank you very much dr sahab
This is so wholesome. Thank you very much!
Thank you for such method of presentation
Clear to the point lucid style ,keep it up
Very Good Doctor exceptional skills.
great way to explain Thank You Sir❤
Thanks for the video. An important point, if a patient has ST elevations on the leads corresponding the the area of ischemia. Then there is no need for cardiac biomarkers. You can diagnose a case of STEMI just on the ECG findings.
But to know the severity
Any chance of thrombolytic therapy
Very Nice illustration.. Thanks.
Thank you very much Sir. Awesome video🙏🙏🙏
You did incredible job. Thumb up
woow.. such a wonderful expl.
You have expalined it so lucidly sir...Thankyou so much for uploading this vedio..Looking forward to watch your vedios on other medical emergencies as well..keep uploading👍
Thank you very much Farhana for such nice comments. I'll surely make more videos on medical emergencies. Stay tuned 😊😊
Sir, You're absolutely amazing 🔥
The nuances in the video are very helpful
Thanks doc
Sir your explanation is just fantastic ...it will help both the students and patients..thanks a lot...need more topics
Sir your videos are amazing and your teaching methodology is awesome. You are a great teacher and a marvellous doctor. Please keep doing great work
Very useful and well explained in such a short time. Well done 🌹🌹🌹
Outstanding
The nicest presentation 👌👏
Thank you sir. It was very helpful. 💗💗
Thank you so much for such a great information in an easy understandable way...
You're lessons are very helpful 🙏
Mashallah Great Teacher👩🏫 ✌
Thnkyou so much Sir ... Easy to understand ....
Thank you for the great explanation doctor 👌🏼
Excellent presentation
Great job
Your explaination its really very good sir thank you so much for your all videos 🙏🙏
Very useful sir , thanking you
Good emergency information
Very knowledgeable sir really appreciate 👍🙏
Great videos for handling emergencies but please mention dosing as well
Straight to the point...thanks
Thank you 😊
Great video, well explained 👏
Excellent. Sir!👌👌👌
You are really great sir
I am your permanent watcher
Your videos are amazing for all doctors and medical students as well
What a fabulous style
Learned a lot from your lectures
Really you are our assets❤❤
So Nice of you Dr. Fazal Subhan for your kind words. Very happy to see this. 😊
Excellent videos
Thank you very much...sir..nice information 👍
Really very informative video .. 👍
Good morning sir. Thank you very much
Very well explained sir
exceptional content
Thank you for information sir
Thank u soo much for the information sir ..u r saviour
It was a good watch, please update on newly added medicine that are used nowadays in CCU and other emergency cases.
Thank you.
Thank you Anshu. Will surely do. 😊
Beautiful explanation ..👌👏
Excellent sir
Excellent 👌
Very nice explanation sir
Good explanation nice video
Thanks a lot
Thank you Sir
Thank you doc for sharing
Great vedio thank you so much sir
GOOD VIDEO! AND THANK YOU!
Thank you Health Ninja! I am glad you found it helpful. 😊
Great explanation 🎉🎉sir
JazakAllah khair ❤️❤️❤️
Very nice
Excellent
Thank you sir.
Thank u so much Doctor.
Sir simply you are awesome...plz make more videos...we love you and your video!! ❤️
Thank you for your love and support Wasim 😊
You are so good. This video is all what l needed. l have tried 5 videos so far n was getting confused. Thank u so much
Shiloh Tayiya, that's very kind of you. I am glad you found it helpful. 😊
Sir, It's very informative really love your content keep posting! ❤❤
Thank you Rohan
Thanku sir very nice class
I hate to bother and please only do this if you want or have time etc., but can you do a video on anti-coagulation labs and what to do with abnormal levels? Anyway, I have said this before, but your channel is amazing. Keep up the great work, and whatever you do, I am sure will be great moving forward. I wish you all the best.
Thank you very much Robert S for your kind words. I will definitely make video on the above mentioned topic. 😊
Thank you
Thank you ❤️
Thank you sir big fan of work🖖
Very nuce
Great sir amazing video.
Thank you 😊
Really very useful sir. Thank you
Thank you 😊
Thank you ♥️
Thank you so much sir❤
I am hungraian last year medical student going for my exam tomorrow. Thank you sir!
You're welcome. Wish you best of luck for your future. 😊
very clear
Very well explained thank you sir 😀
Thank you very much 😊
Thank you 😊
Salam moualaikoum… I am an acute nurse practitioner student… and I loveee you videos.. they helped me soo much. Thank you, thank you so much.
Walaikmasalam! I am very happy to see your comment Hajar D. Stay blessed. Keep supporting 😊
Very informative video
Thank you Singh Jaya!