Myocardial Infarction

I was 6pm -6am duty on a Good Friday last night. I was an on-call nurse. It must supposedly be my day off, but they told me to have my duty.

I was really not feeling well emotionally, but I still went on duty, just to divert my attention from certain events beyond my control. I am the only Emergency Room nurse on duty, but I am with a Nursing Assistant assigned at the triage, Ma’am Johannie.

So, the night went good. I thought it was going to be a benign duty. But when 2AM came, a doctor called our phone, referring a patient who had a myocardial infarction a week ago from another hospital. I told the doctor that we don’t have a functional ICU and our isolation rooms are fully occupied. So, we would not be able to admit the patient.

The patient is 64 years old having chest pains and was treated initially in our triage.

The patient had 92% O2 saturation, BP of 90/50, HR of 88, RR 19, T 36.6.

The patient was asked to undergo antigen test for COvid, and was taken Troponin I too by the Med Tech, as ordered by the resident.

Troponin I levels

Normal range: below 0.04 ng/ml

Probable heart attack: above 0.40 ng/ml

Upon waiting, I took the ECG of the patient and the Respiratory Therapist placed an oxygen 2-3 L to the patient via nasal cannula, as ordered by our resident doctor.

The ordered medications to the patient are as follows:

  1. Omeprazole 40 mg via IV now
  2. Atorvastatin 80 mg/ 1 tab taken orally now
  3. Aspirin 80 mg tab 4 tabs now, which was masticated by the patient
  4. Clopidogrel 75 mg/tab 4 tabs now, which was masticated by the patient
  5. Isordil 5mg/ 1 tab now sublingually
  6. Morphine 2mg IV now

However, we don’t have stocks for Morphine. The patient was in pain. Somehow, it was relieved temporarily by the other medications.

After a few minutes, the result of the antigen test of the patient was positive for COVID.

Our resident doctor made a referral slip of the patient for transfer to hospital of choice.

After the relatives settled the payment, the patient was discharged for transfer to another hospital.

I still learned something new today. Maybe, I should just focus in my work and studies to divert my attention from my beautiful emotional petty concerns in life.

Still, thank You God.

DRUG STUDY:
1. Omeprazole – (Proton Pump Inhibitor) – works by decreasing the amount of acid your stomach makes. It relieves symptoms such as heartburn, difficulty swallowing, and persistent cough
2. Atorvastatin – (HMG CoA reductase inhibitors) – used together with diet to lower blood levels of “bad” cholesterol (low-density lipoprotein, or LDL), to increase levels of “good” cholesterol (high-density lipoprotein, or HDL), and to lower triglycerides (a type of fat in the blood).
3. Aspirin (Salicylate) –  It works by reducing substances in the body that cause painfever, and inflammation. It is used to treat pain, and reduce fever or inflammation. It is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina).
4. Clopidogrel – (P2Y12 inhibitors) – used to lower risk of having a stroke, blood clot, or serious heart problem after a heart attack, severe chest pain (angina), or circulation problems.
5. Isordil – (Nitrate) – A nitrate that dilates (widens) blood vessels, making it easier for blood to flow through them and easier for the heart to pump. Isosorbide mononitrate is used to prevent angina attacks (chest pain).
Isosorbide mononitrate will not treat an angina attack that has already begun.
6. Morphine – (Opiod/ Narcotic) – used to treat moderate to severe pain. Short-acting formulations are taken as needed for pain.
Source: webmd.com, drugs.com