ACUTE MYOCARDIAL INFARCTION - iCCnet SA



ST-ELEVATION MYOCARDIAL INFARCTION

|DATE/TIME |PROCEDURE |

|Admission |Insert 2 insytes |

|Day 0 |ECG |

| |Bloods: G&S, APTT, INR, FBE, ECU, LFT, Mg, Glu, Chol, Trig, |

| |CK, CKMB, Troponin T |

| |ASPIRIN 150-300mg oral chew or dissolve in water |

|00:00 |HEPARIN IV BOLUS (weight adjusted dose according to CIC guidelines) |

| |Flush line with 20mL Normal Saline |

| | |

| |TENECTEPLASE (TNK) INTRAVENOUS BOLUS: |

| |Choose vial size according to patient's body weight. |

| |Reconstitute. Withdraw appropriate volume of Tenecteplase solution |

| |based on patient's body weight. (see table) |

| |Administer Tenecteplase as a single intravenous bolus in ~10 seconds. |

| |Flush line with 20mL Normal Saline |

| |Note: Tenecteplase is incompatible with Glucose 5% |

| | |

| |HEPARIN INFUSION: 25,000unit in 500mL Glucose 5% |

| |Commence Heparin Infusion (weight adjusted) according to CIC guidelines |

| |Titrate according to APTT/Heparin nomogram |

| |Continue for at least 24 hours |

|20 minutes |Assess pain |

|30 minutes |Consider: Beta-Blocker |

| |ECG |

|6 hours |APTT - adjust Heparin rate according to nomogram |

| |CK |

|12 hours |Consider: ACE Inhibitor, 'Statin' |

| |APTT – adjust IV heparin rate according to Heparin/APTT nomogram |

| |CK |

|18 hours |APTT if required (if subtherapeutic at 1200) |

| |CK |

|24 hours |APTT – adjust IV heparin rate according to nomogram |

| |CK, TropT, ECU, LIPIDS, FBE |

|36 hours |APTT if indicated |

RECOMMENDED ADMINISTRATION:

TENECTEPLASE (TNK) RECONSTITUTION: (1)

Reconstitute Tenecteplase powder by adding the complete volume of water for Injections from the prefilled syringe.

Ensure appropriate vial size is chosen according to patient's body weight.

Swirl gently.

Immediately before the solution is to be administered, invert the vial with the syringe still attached , so syringe is below the vial.

Withdraw into syringe appropriate volume of Tenecteplase based on patient's weight.

|Body weight (kg) |Tenecteplase |Tenecteplase |Volume from vial |

| |(IU) |(mg) |(mL) |

|30minutes duration (x)

4) abnormal ECG (x)

ST elevation ( 1mm in two or more continguous leads

LBBB (new or confirmed CK rise)

ST depression in precordial leads suggesting posterior MI

THROMBOLYTIC EXCLUSION CRITERIA: (Reference: Aylward & Burns 6/1999)

1) Active bleeding

2) History of CVA or CNS damage within past 6 months

3) Major surgery or trauma in the past 2 months

4) Non-compressible vascular puncture in the past 2 weeks

5) Uncontrolled hypertension, i.e. systolic >200, diastolic >110

6) Consider PTCA in women who are breast-feeding or pregnant

SIDE EFFECTS: Bleeding

Tenecteplase has a terminal half-life of ~ 2hrs.

Bleeding risk after TNK should be diminished after 10 hours.

REFERENCES:

( Manufacturer 99

( Trissel 10th ed.

( Australian Injectable Drugs Handbook, SHPA, 2nd Ed. 1999

( Martindale 32nd ed.

( FMC Formulary 9th ed. 1999/2000

( Resuscitation from Cardiac Arrest Committee, F.M.C.

( Cardiovascular Drug Guidelines 3rd Ed., 1/95

Victorian Drug Usage Advisory Committee

( TGA

(

10) ACC Acute Myocardial Infarction Guidelines 1996, revision 1999

11) Micromedex

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