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    Pre-Preparation of Primary PCI

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    Tamil
    Pci

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    Pre-Preparation of Primary PCI

    Uploaded by

    Tamil
    1 views13 pages
    Pci

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    Pci

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    Download as pptx, pdf, or txt
    1 views13 pages

    Pre-Preparation of Primary PCI

    Uploaded by

    Tamil
    Pci

    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
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    Pre-Preparation of

    Primary/ Rescue PCI


    By
    Praveenkumar
    Staff Nurse- ER
    ACUTE CORONARY SYNDROME
    • ACS represent a life-threatening
    manifestation of atherosclerosis usually
    precipitated by acute thrombosis, induced
    by a ruptured or eroded atherosclerotic
    plaque, with or without concomitant
    vasoconstriction, causing a sudden and
    critical reduction in blood flow.
    CLASSIFICATION OF ACS

    ACUTE
    CORONARY
    SYNDROME

    UNSTABLE STABLE
    NSTEMI STEMI
    ANGINA ANGINA
    MYOCARDIAL INFARCTION
    • Myocardial infarction MI occur because of
    the sustained ischemia, causing irreversible
    myocardial cell death (necrosis). Thrombus
    formation cause no blood flow to the
    myocardium distal to the blockage,
    resulting in necrosis of myocardium.
    NORMAL RHYTHM vs ST- UPTAKE
    TERRITORIES OF DIFFERENT STEMI’S
    WINDOW PERIOD FOR STEMI
    • Primary PCI is indicated with in 12 hours of onset
    of symptoms, persisting ECG ST-T uptake and
    without any complication. Door to balloon time
    is approximately 30-60 mins after patient arrival
    to care facility.
    • Thrombolytic therapy is indicated with in 6 hours
    after the onset of symptoms
    PRIMARY PTCA
    Primary percutaneous coronary intervention (PCI) refers
    to the strategy of taking a patient who presents
    with STEMI directly to the cardiac catheterization
    laboratory to undergo mechanical revascularization
    using balloon angioplasty, coronary stents,
    aspiration thrombectomy, and other measures.
    Primary PCI is indicated (class I) in patients with ischemic
    symptoms < 12 hours and contraindications to
    thrombolytic therapy (irrespective of the time delay from
    FMC), patients with cardiogenic shock, and patients with
    acute severe heart failure (irrespective of the time delay
    from MI onset);
    RESCUE PCI
    • Rescue percutaneous coronary intervention (PCI) is a
    mechanical reperfusion procedure performed when
    fibrinolytic therapy fails for ST elevation myocardial
    infarction (STEMI). It's defined as an emergent PCI
    that takes place within 12 hours of failed fibrinolysis.
    • Rescue PCI is indicated when there are signs of failed
    fibrinolysis, such as: Persistent chest pain, Worsening
    ST-segment elevation, Heart failure, Hemodynamic
    instability, and Ventricular tachyarrhythmias.
    FIRST AID MANAGEMENT
     ECG confirmation
     Loading dose (DAPT+STATINS)
     Clopidrogrel 300mg Stat (In case of primary PCI full loading with 600mg)
     Brillinta 180mg Stat
     Aspirin 325 mg Stat
     Atorvastatins 80mg Stat
     PPI and antiemetics
     Initial pain management (nitrates or narcotic analgesics)
     Anticoagulation
     Heparin: 60units/kg bolus (Max 5000 units)
     Peripheral iv access (2 Peripheral access preferably in left hand)
     Avoid right metacarpal area for IV access/ go for central access if any supports.
     Acute STEMI with-in window period thrombolytic therapy or primary PCI
    Other Preparations
    • Venous Blood Gas/ serum Renal Parameters
    • Skin preparation
    • Activate Cath-lab and Nursing supervisor
    • Initial Registration
    • Carrying out admission process with FC letter
    • Informed Consent from patient and attenders
    • High risk consent (by doctors)
    Things to accompany with patients
    while shifting
    • Emergency medications (Adre, Atrop, Xylo and flush)
    • Defibrillator with gel
    • Cardiac Monitor
    • AMBU bag
    • Portable Oxygen Cylinder with tubing
    • On-call Cardiac Registrar along with staff nurse
    • TPI generator with TPI Pacing catheter.
    Thank you!

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