Myocardial Infarction (MI,Heart Attack) Treatment in Emergency | Step wise STEMI Management USMLE
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- Опубліковано 4 гру 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. 😊
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
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
The best video ever! you simply wrapped up everything very perfectly! YOU ARE THE BEST!!!
A concise discussion on MI.Thank you so much sir.
8 hours of lecture explained in less than 12 min! 👈🏻👏👏
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.
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
Keep posting this kind of informative video. Thanks
Sir your explanation is just fantastic ...it will help both the students and patients..thanks a lot...need more topics
One of the best and precise in alucid style.Great Lecture
Very Good Doctor exceptional skills.
Many doubts get cleared,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
Good explanation nice video
Good emergency information
Excellent presentation
Great videos for handling emergencies but please mention dosing as well
Your video are the tremendous source of knowledge. I do love it. Loves from Cambodia ❤❤❤
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
The nuances in the video are very helpful
Thanks doc
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. 😊
very useful and simple thank you so much Doc !
Very useful and well explained in such a short time. Well done 🌹🌹🌹
Thank you so much for sharing your knowledge with us ICU RNS,you make it so easy to understand and very informative!
Thank you for such method of presentation
great way to explain Thank You Sir❤
The nicest presentation 👌👏
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. 😊
Crystal clear, thank you very much dr sahab
Excellent videos
woow.. such a wonderful expl.
Clear to the point lucid style ,keep it up
Excellent. Thank you, Doctor.
Thank you so much for such a great information in an easy understandable way...
Sir, You're absolutely amazing 🔥
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 😊😊
This is so wholesome. Thank you very much!
You're lessons are very helpful 🙏
SIR, no doubt best in class ur. u know ur fast also upto mark so link of concentration not broken, ur knowledge is thero. much helpful to us who r in PSU hospitals. sir one suggestion.. plz try to write dose of drugs whenever name of drug comes, u need not explains dose unless some special precautions thanks.
You did incredible job. Thumb up
exceptional content
Excellent
Your explaination its really very good sir thank you so much for your all videos 🙏🙏
Mashallah Great Teacher👩🏫 ✌
Thank you for the great explanation doctor 👌🏼
Very Nice illustration.. Thanks.
Great job
Great explanation 🎉🎉sir
There's exam for me Tomorrow..just saw this video... very helpful.. thanks
Good wishes Dear. Stay blessed 😊
Thank you very much Sir. Awesome video🙏🙏🙏
Very nice
Excellent 👌
Good morning sir. Thank you very much
Beautiful explanation ..👌👏
Really very informative video .. 👍
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. 😊
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. 😊
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. 😊
Very knowledgeable sir really appreciate 👍🙏
Outstanding
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 😊
Excellent sir
Thank you doc for sharing
Very well explained sir
Great video, well explained 👏
Thank you sir. It was very helpful. 💗💗
Very useful sir , thanking you
Great vedio thank you so much sir
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. 😊
Thank u soo much for the information sir ..u r saviour
Thank you Sir
Very nice explanation sir
Thank you
Thank you sir big fan of work🖖
JazakAllah Alhumdullilah AllahuAkbar
Thank you sir.
Thanku so much for my emergency in my exam😅
Thank you for information sir
Very concise. I would point out that a significant number of MI pts. have "stuttering" courses over periods of time longer than the usual PTCA and or thrombolysis window of opportunity. Significant amounts of stunned myocardium can recover function with intervention. Pts. should not be denied PTCA when they cannot tolerate platelet inhibition because of some particular contraindication. Simple balloon dilitation without stent can be very effective. I have seen a number of pts. who were described as failing to respond to NTG. The simple intervention of sitting the pt. up to take advantage of gravity in both pre and afterload reduction can seem miraculous. I have seen pts. with KNOWN CAD for whom beta blocker, platelet inhibition , statin, etc. and available NTG were not even prescribed!
This is certainly malpractice. This is not sophisticated medicine; it's basic.
Thank you so much for sharing this wonderful piece of information. 😊
Thank u so much Doctor.
Straight to the point...thanks
Thank you 😊
thanks for your great video. what are the differences in treatment of inf mi vs ant mi?
Thank you very much...sir..nice information 👍
Excellent. Sir!👌👌👌
JazakAllah khair ❤️❤️❤️
Sir simply you are awesome...plz make more videos...we love you and your video!! ❤️
Thank you for your love and support Wasim 😊
Waiting for more videos Sir
Allah bless u ❤ from 🇮🇳
Thanku sir very nice class
Very informative video
Thank you Singh Jaya!
Sir, It's very informative really love your content keep posting! ❤❤
Thank you Rohan
Thnkyou so much Sir ... Easy to understand ....
This kind of medical lecture merits to be in exclusively in conferences cmes not in u tube videos
Dr A.Das
Sir request you to make a simplified video on ECG for UG's.
Nice classss, 🥰😍😍😍😍😍