Myocardial infarction (MI) is an acutely emerging condition, which is characterized by the development of a focus of necrosis in the myocardium due to a cessation of oxygen supply to the site.
Acute coronary syndrome (ACS) is a symptom complex that allows one to suspect ischemic changes in the myocardium (MI, unstable angina). Diagnosed on the basis of pain syndrome and ECG signs.
Early diagnosis, timely hospitalization and successful emergency care for myocardial infarction significantly reduce mortality and disability rates and improve the results of further treatment.
Assisting the patient at home before the arrival of an ambulance
The ability to navigate in time and provide adequate support to the patient before the arrival of the ambulance team significantly increases his chances of survival.
First aid for myocardial infarction should be provided immediately.
Algorithm of actions
- Call an ambulance immediately (in a conversation with the dispatcher, formulate the symptoms as clearly as possible, voice the suspicion of myocardial infarction, so that a specialized cardiology or resuscitation team comes to the call).
- Provide the patient with a semi-sitting position (The elevated position of the upper half of the torso reduces the preload on the heart).
- Try to calm the patient down (emotional and physical stress increases the release of vasoconstrictors, which increases myocardial ischemia and increases its oxygen demand).
- Provide oxygen supply (open windows, doors, turn on the air conditioner).
- Remove outer clothing and loosen all body compression (tie, belt, necklace, etc.).
- If possible measure blood pressure and calculate the pulse... With severe tachycardia, take "Anaprillin" 1 tab., Hypertension - "Captopril" 1 tab.
- Give "ASK" (150-325 mg) or Clopidogrel (100 mg)... The effect will be faster if the tablets are chewed.
- Sublingually give 1 tab. "Nitroglycerin"... Repeat taking every 5 minutes (but not more than 3 doses).
- Until the arrival of an ambulance, it is forbidden to take non-narcotic analgesics!
If the patient suddenly lost consciousness, stopped breathing and cardiac arrest occurred, it is necessary to perform cardiopulmonary resuscitation before the arrival of doctors:
- position the patient lying on his back, tilt his head back, place a roller under the neck, extend the lower jaw (prevention of airway obstruction with the tongue);
- check the pulse on the carotid artery;
- perform an indirect cardiac massage and do artificial respiration with a frequency of 30: 2, if the procedure is performed by one person, or 15: 1, if two people are involved. Pressing should be done quickly (100 per minute), rhythmically and with sufficient force to ensure cardiac output;
- check every 2-3 minutes for a pulse.
Pre-hospital emergency
The standard of arrival of the EMF brigade in the city is 10 minutes, outside the city limits - 20 minutes after the call is registered in the dispatch service. Taking into account the weather, epidemiological and traffic conditions, the time may be exceeded (no longer than 10 minutes).
According to the protocol, the algorithm of the team's actions upon arrival to the patient includes:
- Taking anamnesis (if possible).
- If necessary, carrying out resuscitation measures (mechanical ventilation, chest compressions, defibrillation).
- Examination and physical examination with an assessment of the state of the cardiovascular and respiratory system.
- Registration of 12 ECG leads with repetition in 20 minutes.
Pulse oximetry (at saturation below 95% - oxygen support by mask or through nasal cannulas 3-5 l / min.).
- Determine the level of troponins I, T in the blood (if a portable test is available).
- Providing venous access.
- Actually emergency medical care:
- "Nitroglycerin" 0.5-1 mg every 10 minutes. With severe pain syndrome, intravenous drip under the control of SBP (not lower than 90 mm Hg);
- relief of an anginal attack with narcotic analgesics. Preferably "Morphine" 2-5 mg every 10-15 minutes until the cessation of pain syndrome (total dose not higher than 20 mg);
- "ASK" 150-325 mg chewing, if the patient did not take it before the arrival of the ambulance;
- conducting double antiplatelet therapy - "Ticagrelor" 180 mg, in its absence, "Clopidogrel" is prescribed at a dose of 300 mg;
- short-acting beta-blockers - Propranolol, Metoprolol;
- reduce the load on the myocardium by lowering blood pressure and correcting hemodynamic disorders.
If possible, it is recommended to carry out thrombolytic therapy for TLT (streptokinase, alteplase, actilyse) at the prehospital stage. If thrombolysis can be carried out within 2 hours from the onset of ischemic changes (optimally within 60 minutes), this can interrupt the development of necrosis in myocardial infarction, reduce the affected area and significantly reduce mortality. TLT is not effective if more than 12 hours have passed since the onset of the pain attack. Also, the procedure is not performed in the presence of absolute contraindications: intracranial bleeding or hemorrhagic stroke in the last 3 months, malignant neoplasm of the brain, aneurysm of the abdominal aorta with a tendency to dissection, bleeding from the gastrointestinal tract during the last month, hemostatic disorders.
All patients with ACS are hospitalized in the intensive care unit of a specialized cardiological hospital with the possibility of performing emergency angiography and reperfusion interventions.
What determines the success of providing first aid to a patient with myocardial infarction?
The quality of providing first aid to a patient depends on many factors:
- knowledge of the person providing assistance, the algorithm of actions in case of a heart attack, the ability to perform resuscitation actions;
- time elapsed from attack to onset of action;
- medication and instrumental support (tonometer, "Nitroglycerin", "Aspirin");
- staffing of ambulance teams with the necessary equipment, drugs, personnel qualifications;
- remoteness from specialized cardiology departments.
There are also factors that aggravate the course of a heart attack, and thereby reduce the chances of success:
- age over 70;
- concomitant pathology (diabetes mellitus, obesity, kidney pathology, widespread atherosclerosis, hypercholesterolemia, hypertension);
- painless onset of ischemia or atypical clinical picture;
- an extensive focus of necrosis (transmural MI) with cardiogenic shock;
- the occurrence of severe arrhythmias and cardiac conduction disorders.
Conclusions
Rationally provided first aid to a patient with MI directly increases the patient's chances of survival and reduces the likelihood of further complications.
As world practice has shown, many deaths occur even before the arrival of specialized medical teams.
Therefore, it is very important to train patients to recognize the first signs of an attack and to be able to help themselves at the very beginning of the situation. All patients at risk should follow the doctor's recommendations and adhere to the principles of a healthy lifestyle.
It is also important to inform the patient's relatives about how to recognize the onset of ischemia and about the rules for providing first aid for a heart attack at home.
