Page 52 - Critical Care Notes

4223_Tab02_045-106 29/08/14 10:00 AM Page 46

CV

Management
■ Administer oxygen to maintain SaO 2 >93%.
■ Establish IV access.
■ Perform continuous cardiac monitoring.
■ Administer SL nitroglycerin tablets or oral spray, every 5 min × 3 doses. If
pain persists, IV nitroglycerin may be started.
■ Monitor for hypotension and headaches from vasodilatation.
■ Administer non-enteric coated aspirin (162–325 mg) and have patient chew
it, if not already on daily dose.
■ Administer IV morphine, 4–8 mg initially with increments of 2–8 mg
repeated at 5–15 min intervals until pain is controlled. Use lower dose
in elderly patients.
■ Monitor for hypotension and respiratory depression.
■ Unless contraindicated, administer a beta blocker.
■ Administer angiotensin converting enzyme inhibitors (ACE-IS) and
angiotensin receptor blockers (ARBs) if patient had moderate to severe MI
with reduced heart’s pumping capacity.
■ Administer calcium channel blockers if symptoms persist after NTG and
beta blockers given.
■ Monitor and immediately treat arrhythmias; pay attention to electrolyte
disturbances (especially potassium and magnesium), hypoxemia, drugs, or
acidosis.
■ Administer clopidogrel 300–600 mg loading dose (600 mg preferred dose).
■ High-risk patients with NSTEMI ACS should also receive unfractionated
heparin or low-molecular-weight heparin (LMWH) and IV platelet glycopro-
tein IIb/IIIa complex blockers (tirofiban, eptifibatide), as well as ASA, clopido-
grel, and beta blockers.
Unstable Angina
Unstable angina is the sudden onset of chest pain, pressure, or tightness result-
ing from insufficient blood flow through coronary arteries.

Pathophysiology
Atherosclerosis → obstruction of coronary arteries → decrease blood flow
through coronary arteries → decrease oxygen supply to myocardial demand for
O 2 during exertion or emotional stress → angina.

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