美國(guó)重癥醫(yī)學(xué)(FCCM)的基礎(chǔ)教程急性冠脈綜合征_第1頁
美國(guó)重癥醫(yī)學(xué)(FCCM)的基礎(chǔ)教程急性冠脈綜合征_第2頁
美國(guó)重癥醫(yī)學(xué)(FCCM)的基礎(chǔ)教程急性冠脈綜合征_第3頁
美國(guó)重癥醫(yī)學(xué)(FCCM)的基礎(chǔ)教程急性冠脈綜合征_第4頁
美國(guó)重癥醫(yī)學(xué)(FCCM)的基礎(chǔ)教程急性冠脈綜合征_第5頁
已閱讀5頁，還剩18頁未讀， 繼續(xù)免費(fèi)閱讀

下載本文檔

版權(quán)說明：本文檔由用戶提供并上傳，收益歸屬內(nèi)容提供方，若內(nèi)容存在侵權(quán)，請(qǐng)進(jìn)行舉報(bào)或認(rèn)領(lǐng)

文檔簡(jiǎn)介

MI1

AcuteCoronarySyndromes?ObjectivesIdentifypatientswithacutecoronarysyndromesOutlineacutemanagementofunstableangina,non-QwaveandQ-wavemyocardialinfarctionIdentifypatientswhoarecandidatesforrevascularizationinterventionsRecognizehigh-riskpatientsandearlycomplicationsofmyocardialinfarctionMI2

?AcuteCoronarySyndromesOverlappingclinicalconditionsUnstableanginaNon-Q-wavemyocardialinfarction(MI)Q-wave(ST-segmentelevation)myocardialinfarctionVariabledegreesofcoronaryarteryocclusionProcessofinflammation,plateletactivation/aggregation,thrombusformation,microembolizationMI3

?ChestPainAlgorithmPatientwithchestpain

History,physicalexamination,ECG,chestradiograph

MIwithST-segmentelevationpresent?

Yes

ToMI

algorithmNo

Unstableanginapresent

No

Consideralternativeevaluation

UnstableAnginaandNon-Q-WaveMyocardialInfarctionEvaluationandmanagementsimilarPreliminarydiagnosisClinicalsymptomsRiskfactorsElectrocardiogramCardiacenzymesAssessshort-termrisks

ChestPainAlgorithm Unstableanginapresent

Admit,monitorECG,O2

Aspirin Sublingualorspraynitroglycerin Intravenousnitroglycerin Heparin(unfractionated,lowmolecularweight)

-blocker

GPIIb/IIIainhibitor(high-riskpatients)

Symptomsrelieved?

Yes

Elective

evaluation No(nextslide)

ChestPainAlgorithm

Symptomsrelieved?

No

Adjustdoseofnitroglycerin,-blockerConsidercalciumchannelblocker

Symptomsrelieved?

Yes

Elective

evaluation No

Emergencyconsultation/transferCautionsNitroglycerinAvoiddecreaseinbloodpressure10%Adjustunfractionatedheparininfusion-blockercontraindicationsHeartrate<60beats/minModerate-severeheartfailureAtrioventricularblock>firstdegreeSystolicbloodpressure<100mmHgPeripheralhypoperfusionBronchospasticdiseaseQ-Wave(ST-segmentelevation)MyocardialInfarctionOcclusionofcoronaryarterybythrombusProgressionofnecrosiswithtimeDiagnosisClinicalsymptomsElectrocardiogramCardiacenzymesAdmit,O2

AspirinSublingual,sprayand/orivnitroglycerinMorphineHeparin(unfractionated,lowmolecularweight)

-blocker

Candidateforthrombolytic?

No

Emergencyconsultation/transferforprimaryPTCAQ-Wave(ST-segmentelevation)MyocardialInfarctionDefiniteIndicationsforThrombolyticTherapy

ConsistentClinicalSyndromeChestpain,newarrhythmia,unexplainedhypotensionorpulmonaryedemaDiagnosticECGSTelevation

1mmin

2contiguousleadsornewleftbundle-branchblockLessthan12hourssinceonsetofpainRelativeIndicationsforThrombolyticTherapy

ConsistentClinicalSyndromeChestpain,newarrhythmia,unexplainedhypotensionorpulmonaryedemaNondiagnosticECGLeftbundle-branchblockofunknownduration

AbsoluteContraindicationsforThrombolyticTherapy

HistoryofhemorrhagicstrokeStrokeorCVAwithin1yearAllergytotheagentSurgeryortraumainpast2wksKnownintracranialneoplasmSuspectedaorticdissectionActiveinternalbleeding

(exceptmenstruation)RelativeContraindicationsforThrombolyticTherapy

Severeuncontrolledhypertension(>180/110mmHg)HistoryofchronicseverehypertensionCVAorintracerebralpathology>1yragoCurrentanticoagulantuseRecenttrauma(within2-4weeks)AllergyorpriorexposuretostreptokinaseRelativeContraindicationsforThrombolyticTherapy

ActivepepticulcerdiseaseSignificanthepaticdysfunctionRecent(2-4weeks)internalbleedingBleedingdiathesisNoncompressiblearterialorcentral

venouspuncturePregnancyQ-Wave(ST-segmentelevation)MyocardialInfarction Candidateforthrombolytic?

No

Emergency

consultation/transfer Yes forprimaryPTCA

Thrombolyticagentgiven

ComplicationsofMI

Yes

Emergency

consultation/transfer No

ElectiveevaluationContinuingTherapyHeparininfusionafterthrombolysis(exceptafterstreptokinase)AspirindailyNitroglycerinfor24-48hours

-blockerunlesscontraindicatedAngiotensin-convertingenzyme(ACE)inhibitorwithinfirst24hoursCardiologyconsultationand/ortransferComplicationsofMyocardialInfarction

Heartfailure:SystolicBP>100mmHgVasodilatorsNitroglycerinNitroprussideInotropesDobutamineMilrinoneLoopdiureticsHeartfailure:SystolicBP<90mmHgVasopressorsinitiallyNorepinephrineDopamineInotropeswhenBPstableConsiderPTCAorintra-aorticballoonpumpCardiologyconsultationComplicationsofMyocardialInfarctionComplicationsofMyocardialInfarction

RecurrentischemiaorinfarctionFollowunstableanginaalgorithmCardiologyconsultationConsiderrepeatthrombolysiswithnon-streptokinaseagentAngioplastyorbypassComplicationsofMyocardialInfarction

ArrhythmiasProphylacticdrugsnotrecommen

溫馨提示

  • 1. 本站所有資源如無特殊說明，都需要本地電腦安裝OFFICE2007和PDF閱讀器。圖紙軟件為CAD,CAXA,PROE,UG,SolidWorks等.壓縮文件請(qǐng)下載最新的WinRAR軟件解壓。
  • 2. 本站的文檔不包含任何第三方提供的附件圖紙等，如果需要附件，請(qǐng)聯(lián)系上傳者。文件的所有權(quán)益歸上傳用戶所有。
  • 3. 本站RAR壓縮包中若帶圖紙，網(wǎng)頁內(nèi)容里面會(huì)有圖紙預(yù)覽，若沒有圖紙預(yù)覽就沒有圖紙。
  • 4. 未經(jīng)權(quán)益所有人同意不得將文件中的內(nèi)容挪作商業(yè)或盈利用途。
  • 5. 人人文庫網(wǎng)僅提供信息存儲(chǔ)空間，僅對(duì)用戶上傳內(nèi)容的表現(xiàn)方式做保護(hù)處理，對(duì)用戶上傳分享的文檔內(nèi)容本身不做任何修改或編輯，并不能對(duì)任何下載內(nèi)容負(fù)責(zé)。
  • 6. 下載文件中如有侵權(quán)或不適當(dāng)內(nèi)容，請(qǐng)與我們聯(lián)系，我們立即糾正。
  • 7. 本站不保證下載資源的準(zhǔn)確性、安全性和完整性, 同時(shí)也不承擔(dān)用戶因使用這些下載資源對(duì)自己和他人造成任何形式的傷害或損失。

評(píng)論

0/150

提交評(píng)論