28 ‘CASE FILES: Internal Medicine nial Assasement + Focused history and physical examination + Evaluate peripheral pertusion = ECG—ST elevation >1 mm in at least 2 anterior, inferior, lateral lads; ST depression in anterior lead (post- Ml + Carciac enzymes [No ST atevaton Negative} | Positve immediate therapy lenzymes negative for J | __tortl lev access rage as unstaio anginal + Cardiac monitring [Manage as unstable ang + Morphine IV + Oxygen with continuous ‘mentoring ‘ConsidarTorTEPEMTESION | |«Nitroglyoerin SL or spray therapy Aspirin 325 mg, cnewable| Ether thrombolysis or angiopiaty Thrombolysis neither appropriate) | [Angioplasty + No containcation avaliable stabilze + Catheter lab immediately sa wthin 2-6 hours available (<1 hour to +a within 12 hour with repertusion) angior persistant chest pain and + Contraincication to te SST elevation therapy’ +1 contraindicated or + Carciogenie shock cardiogenie shack, + Retractory ventricular consider angioplasty antythmia + Large infarct size [rial tabizaton Evaluate ana te Consider angiopaaty] [ot acute Ml 3 complications [Ratona erp Fyrom [Sar Frere romana pertnsion infer Mt ight venice fVenuisionoxygenaton |lpsptey muscle net | reteve pan |fistreion mmesate primary Pra fystuncion [ivnitogyeein |fave pia votene | Hriemodynamic ranting [Acute sever AR | Bewiccke fusing NS forma caine [Extra nites batoon pump [fetcua septa tae] Vasopressors: dopamine! ‘Dyamytimialconduaton daturbancas ‘AEe Surge 7 (aaravenscaa ainda [vonioaaaayeara aon vaajeardalavovenicuar Boa] fc earsovrsion tyme or |Jostortate immediately opine 5-10.09 remodyramieHstay lug: kaocaina, procainamide, [andy pacemaker tik tor bruce: edenosne, metopota, |arnadarone ‘Complate hear lock oananide Wo popnyact idocaine |) New et buna branch block wath primary atiovenelr Manta K"> 4 meat anda |-emean bon Figure 1-4. Algorithm for assessment and Weatment of chest pain