Nursing care of patients with acute myocardial infarction with ST-segment elevation with STEMI fast track: Two case comparative studies

Abstract

The coronary artery occlusion was severely from thrombotic was causes of occlusion of blood flow to myocardium and resulting in acute myocardial infarction with ST-segment elevation (STEMI). The Chief complaint include chest pain, Shortness of breath, fatigue, palpitations, sweating and maybe to sudden cardiac arrest were emergency and life-threatening. The nurse work in emergency room must be able to quickly patients assess in minutes to provided antiplatelet medication according to doctor order in time, as well as preparing to refer-out the patient with STEMI fast track to the host hospital, to percutaneous coronary intervention (PCI) and for the patient to survive. 

Objective: The purpose to study nursing care of the patients with acute myocardial infarction with ST-segment elevation with STEMI fast track by comparing two case studies.

Methods: The methods were selecting case studies of the patients with acute myocardial infarction with ST-segment elevation who received treatment in the emergency room, Namyuen Hospital. The data were collected between June to August 2023. The data analysis accordance with the concept of nursing process, emergency patient care and fast track care.

Result: Both men patients had chief complaint include chest pain, shortness of breath, fatigue, and sweating. The 1^st and the 2^nd patient aged 50 and 60 years, EKG found ST elevated at aVF, V3-V6, V3R, V4R, and at aVF, V2-V3, chest pain score 5/10 and 10/10, consult a cardiologist and a STEMI diagnosis within 42 and 65 minutes, administer Streptokinase within 50 and 70 minutes, respectively. The 1^st patient after administer Streptokinase had chest pain score 2/10. The 2^nd patient after administer Streptokinase had hypotension, administer 0.9%NSS and Dopamine (2:1) then normal blood pressure. Both patients were STEMI fast track, refer-out to host hospital, had CAG and PCI. After the procedure: the 1^st patient had improved symptoms. the 2^nd patient had stupor symptoms and improved in later.

Conclusion: Nursing care of patient with STEMI, the nurse must coordinate to the host hospital for a correct diagnosis and administer Streptokinase to antiplatelet as quickly as, surveillance for side effects of medicine. In the refer-out stage with STEMI fast track: the nurses must use their knowledge, skills and experience to observed and assess the patients in ambulance car at all times to provide timely, until arrived the host hospital for patients to received treatment deserved.