Emergency Department

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Case outline

Peter Brown is a 58-year-old gentleman who has experienced an episode of crushing central chest pain while at work. Peter works as a taxi driver and a colleague has taken him to the Accident and Emergency Department. On admission, Peter is sweaty, clammy, nauseated and short of breath. He is complaining of chest pain radiating to his left arm. This is Peter’s first presentation to hospital and he has no relevant past medical history. Peter smokes approximately 20–30 cigarettes per day and takes alcohol at weekends only. Peter is anxious and is concerned that his wife and children are informed. He also states his father died suddenly following a heart attack a number of years ago. Peter is immediately triaged and taken to the resuscitation room. You are the receiving nurse. Observations on admission include:

Respiratory rate: 18 breaths per minute Oxygen saturations: 95% Blood pressure: 150/90 mmHg Pulse: 94 beats per minute Temperature: 37ºC.

On admission to hospital an electrocardiograph (ECG) has been undertaken. Peter has been diagnosed with an anterior ST segment elevation myocardial infarction (anterior STEMI). Blood sles have also been drawn for urea and electrolytes (U#038;E), full blood picture (FBP) and highly sensitive troponin T.

Peter’s ECG shows ST segment elevation in leads V2, V3, V4 and to a lesser extent in V5. This is typical of an anterior ST elevation myocardial infarction (Hatchett and Thompson 2007). This ECG indicates that Peter should be treated urgently with a view to reperfusion therapy. Reperfusion therapy involves either thrombolytic therapy or being taken to the cardiac catheterization laboratory in order that a stent may be inserted in the culprit coronary artery.

The cardiologist has decided to take Peter to the cardiac catheterization laboratory (cath lab) to undergo a percutaneous coronary intervention (PCI) as opposed to giving him thrombolytic therapy. The cardiologist wants Peter to have clopidogrel 600 mg and aspirin 300 mg prior to transfer to the catheterization laboratory.

Following Peter’s transfer to the cath lab, he had a stent deployed to his left anterior descending coronary artery. Subsequently Peter made a full uncomplicated recovery and was discharged four days later.

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