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| Streptase: |
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Registration No.:
Reference No.: |
X/31131 (1,500,000 IU)
H2863 (750,000 IU) |
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| DEPARTMENT OF HEALTH CHAPTER
5 |
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MYOCARDIAL
INFARCTION, ACUTE (AMI)
Description
AMI is caused by the complete or partial occlusion of a
coronary artery and requires prompt hospitalisation and
intensive care management.
NB. Not all features have to be present.
The major clinical feature is severe chest pain with the
following characteristics:
Site-retrosternal or epigastric
Quality-crushing or burning pain or discomfort.
Radiation - to the neck and/or down the inner part of
the left arm
Duration - at least 20 minutes and often not responding
to S/L nitrates.
Occurs at rest
And may be associated with:
Pallor Pulmonary
oedema Sweating
A drop in blood pressure
Arrhythmias
Emergency treatment before transfer.
Cardiopulmonary resuscitation if necessary
Oxygen, 40% by facemask
Aspirin soluble, oral, 300mg as a single dose as soon as
possible.
Isosorbide dinitrate, sublingual,
5mg, every 5-10 minutes as needed for pain relief to a
maximum of 5 tablets.
Morphine, slow IMI 10-15mg, can be repeated if necessary
for pain relief.
Beware of Hypotension
OR
Morphine 15mg diluted with 14mls of water for injection
or normal saline.
Administer 1ml/min until pain relief is obtained.
Streptokinase intravenous 1.5 million iu, diluted in
100ml dextrose 5% or sodium chloride 0.9% and given over
30-60 minutes. (Doctor initiated).
NB. Only for confirmed ST - elevation myocardial
infarction or new LBBB and if patient presents within 6
hours of
onset of pain.
Contraindications:
Known bleeding disorder
Stroke within last 6 months GIT
bleeding within last 3 months or peptic ulcer
Recent major trauma, surgery or head injury.
Streptokinase given within past 1 year of known allergy
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Monitor
continuously and also during transfer:
Pulse Blood pressure
Respiration depth and rate (count for a full minute)
REFERRAL
URGENT ALL SUSPECTED OR DIAGNOSED
CASES |
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STREPTOKINASE EMERGENCY
TREATMENT
for confirmed ST elevation or new LBBB
Cardio
pulmonary resuscitation PRN
Oxygen 100% continuously by nasal
cannula
Aspirin soluble 300mg as single dose
Morphine IM 10-15mg for pain
or
Morphine IV 1mg/min
titrated to max 10mg
Dilute Morpine IV in 10mls water for injection or
10mls sodium chloride 0.9%
Isosorbide
dinitrate sublingual 5mg every 5-10 mins (max 5
tablets)
Streptokinase
IV (Streptase) 1.5 million iu diluted in 100mls
dextrose 5% or NaCl 0.9% given over 30-60 minutes
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