Training | Pain Management

ISURA 2012 Lecture

Samer Narouze MD, MSc, DABPM, FIPP
Clinical Professor of Anesthesiology and Pain Medicine, OUCOM
Clinical Professor of Neurological Surgery, OSU
Associate Professor of Surgery, NEOUCOM
Chairman, Center For Pain Medicine
Summa Western Reserve Hospital
Cuyahoga Falls OH, USA

David Provenzano MD
Executive Director
Institute for Pain Diagnostics and Care
Ohio Valley General Hospital Pennsylvania, USA

www.usra.ca
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Myocardial Infarction (MI,Heart Attack) Treatment in Emergency | Step wise STEMI Management USMLE

myocardial infarction emergency treatment and management is highly tested topic on usmle step 2 ck.STEMI heart attack inferior wall mi management in emergency department is found quite challenging by many students across the globe. this video gives you a step wise approach to mi treatment in emergency . stemi myocardial infarction treatment guidelines are updated quite oftenly but the basic management has always been the same. emergency heart attack management .heart attack(myocardial infarction) signs and symptoms are also explained in this video by a case description in the very beginning.
nitial medical therapy during STEMI consists of oxygen administration, antiplatelet therapy (aspirin, thienopyridines and glycoprotein IIb/IIIa inhibitors), anticoagulation (heparin or bivalirudin), anginal pain relief with nitrates and morphine, and beta-blockade. Medical therapy upon hospital discharge may include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists and HMG CoA reductase inhibitors.

Aspirin: Aspirin should be chewed at a dose of 162 to 325 mg immediately once STEMI is diagnosed unless a contraindication exists. Lifelong therapy using 75-162 mg daily should follow upon hospital discharge.

Thienopyridines: P2Y212 receptor antagonists (clopidogrel, prasugrel, ticagrelor, and ticlopidine) are indicated in all STEMI cases unless surgery is needed. Clopidogrel can also be used as an adjunct to fibrinolytic therapy in patients intolerant to aspirin. If coronary artery bypass grafting is required, these agents should not be used. These agents must be discontinued for 5-7 days prior to CABG unless urgent and the bleeding risk is less than the benefit of revascularization. Regardless of the type of stent used during PCI, thienopyridines are preferred to be continued for 12 months if possible. Prasugrel is not recommended in a patient with a prior history of stroke or TIA. Ticlopidine is rarely used due to the risk of thrombocytopenia and TTP (thrombotic thrombocytopenic purpura).

Glycoprotein IIb/IIIa inhibitors: These drugs include abciximab, eptifibatide, and tirofiban. They very strongly inhibit platelet function by blocking the binding of fibrinogen to the activated glycoprotein IIb/IIIa receptor complex. Any of these agents may be used in addition to aspirin, a thienopyridine and anticoagulation (except with bivalirudin) at the time of PCI in high risk patients with STEMI. Using glycoprotein IIb/IIIa inhibitors prior to PCI does not have strong data to support its use at the present time.

Anticoagulation: Full anticoagulation should be started in all STEMI patients unless a contraindication exists. Either unfractionated heparin, low molecular weight heparin (enoxaparin or fondaparinux) or bivalirudin can be used. Unfractionated heparin for 48 hours total and low molecular weight heparin for 8 days or until hospital discharge.

Nitrates: Nitrates are helpful to treat angina symptoms, hypertension and heart failure during STEMI, however no clinical data exists to show a mortality benefit and thus their use is individualized. The use of nitrates should not preclude using drugs that do show a mortality benefit.
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ANGINA & CHEST PAIN EVALUATION: https://www.youtube.com/watch?v=AEvVcCPOp_E&t=539s

CUSHING SYNDROME: https://www.youtube.com/watch?v=7MPki…

BLOOD IN STOOLS EVALUATION: https://www.youtube.com/watch?v=IO2yg…

CHRONIC DIARRHEA WORKUP: https://www.youtube.com/watch?v=3_STY…

ACUTE DIARRHEA WORKUP: https://www.youtube.com/watch?v=AX2DM…

JAUNDICE WORKUP:https://www.youtube.com/watch?v=q9mo9…

GERD: https://www.youtube.com/watch?v=tFLb1…

DYSPHAGIA WORKUP: https://youtu.be/GFOxWzwisJk

TUBERCULOSIS WORKUP: https://youtu.be/gi2ECteueXs

ESOPHAGEAL VARICES: https://www.youtube.com/watch?v=X308-…

PULMONARY EMBOLISM WORKUP: https://youtu.be/kKH5CYFM9FE

THYROID NODULE WORKUP: https://youtu.be/d_MMWxilTu4