Nursing Case: Myocardial Infarction

Before my shift ended today, a patient came in the ER with the chief complaint of chest pain 2 hours prior to admission. He came in at around 6 am. He was transferred to a stretcher. Initial Vital Signs were: T= 36.5 degrees Centigrade per axilla; CR = 70 bpm; RR = 23 cpm; BP = 110/70 mmHg. We immediately called up the the technician to do a 12-leads ECG. We then administered oxygen via nasal cannula at 3 liters per minute(LPM). He was also attached to a pulse oximeter. Initial Oxygen Saturation was around 89%.

The Resident on Duty(ROD) immediately ordered for the oxygen to be administered via face mask and at 10 LPM. The oxygen saturation then went up gradually up to 96%. The 12-Leads ECG result was as expected - a myocardial infarction. The doctor ordered Plain Normal Saline Solution 1 liter for the patient's IV line. I inserted the IV at the left cephalic vein using a gauge 20 needle. A fast drip or "volume challenge" of 100 mL was done. The BP was then rechecked but it was now at 70 palpatory. The ROD then ordered to start Dopamine drip at 5 ugtts/min which was attached as piggyback to the above mainline IVF.

The patient also experienced vomiting to a whitish vomitus in small amounts. The chest pain he experienced just by his facial expression was excruciating. Tramadol 1 amp IVTT now was also ordered and given. Patient also complained of defecating and was allowed to do so but with precautions to do it slowly and avoid straining. He defecated to a brownish formed stool in moderate amount. The doctor also ordered for the insertion of a Foley Catheter which was also done successfully with immediate output of approximately 200 cc. Dobutamine drip was also attached as ordered starting at 5 ugtts/min to titrate for BP <90.

The patient also had an order for a chest XRAY PA view and was done. He was then fixed and brought to the ICU for close monitoring. There was also a pending order for starting another IV line for a Heparin drip of D5w 86 cc + 10,000 cc via soluset. The patient is now in the ICU for further care and management.