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HPI: 45 yom brought to the ER with excruciating stabbing pain on chest/inner arm for 20 min. No history of previous attack, but hypertensive c BP 190/ 96 when last taken. He is conscious but looks anxious. VS: temp-97, pulse-86/min,resp. rate-33/min,

Step I : Emergent management: A, B, C, D- O2, IV access

Step II : Focused PE: Heent/Neck, Chest/Lungs, Heart/Cv, Abdomen, Extremities

Step III : Diagnostics: EKG, CXR, CK-mb, Troponin-I, CBC, Chem –7, Continuous cardiac monitoring

Treatment:MONA 1. NTG 0.4mg sl 2. Aspirin 3. Morphine if patient is in pain 4. ACE Inhibitor (onopril) 5. Depending on time since onset (if 3 h or less), consider t-PA if not contraindicated or cardiac cath. 6. Consider NTG drip. Other antihypertensive you may consider is labatelol or nipride( more severe cases).

Step IV: Changing pt’s location 1. Admit Pt. to CCU, if patient is symptomatic send to ward. 2. Repeat cardiac markers 3. D/C cardiac monitor after 24 hours if patient is stable 4. When stable, consider sub-maximal exercise test 5. All Pts. with MI should go home on B-blockers 6. Check lipid profile 7. Counsel on healthy life style prior to discharge 8. Make appointment to see him in about a week

STEP V: Educate Pt’s family, Console patient, stop smoking, diet, excercise.

STEP VI: Final Diagnosis.AMI

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