4)STEMI
✅Hx:Chest pain( most common)
Retrosternal pressure squeezing or heaviness lasts >20 minutes with radiate to left arm, both arms shoulder, neck, jaw or back
Not relieved by rest(جدا مهم)

Associated symptoms
Dyspnea(هواية تشوفوها)
Sweating (diaphoresis)
Nausea/vomiting
Palpitations
Dizziness or syncope

خليها بالك شغلة تنتبه عليها بالطوارئ
Elderly and diabetic patients have atypical presentation:
Epigastric pain
Dyspnea alone

✅IVx and Lab sending :ECG,S troponin titer ,CBC ,RFT ,RBS

✅:
1)O2 Mask if patient SpO₂ <90% or patient dyspnic
2)Aspirin tab 300 mg oral(ثلاث حبات)
3)Plavix tab 300 mg oral (اربع حبات)
4)Heparin 1CC SC
5) Tramal amp+ Plasil amp IV slowly
6)Antihypertensive Angised tab SL (according to type not all MI) ❌🔥❌

✅Decision:
تبليغ المقيم الاقدم باقصى سرعة ممكنة

Patient position : مهم
Stable MI: Semi-sitting position

MI with pulmonary edema or severe dyspnea (Anterior MI): sitting position

Inferior MI with RV infarction + hypotension: Supine position

5)SVT:
✅Hx:palpitation , Dyspnic and SOB, may be chest pain ,Dizziness or anxiety or diaphoresis or syncope.

✅IVx:ECG
Regular tachycardia, narrow QRS

✅Management:
1)BP measurement
2)SpO₂ (Oximeter)➡️Oxygen only if hypoxemic
3)IV access(cubital fossa) مهم جدا

Determine whether the patient is unstable or stable

Unstable SVT:
• Hypotension(SBP <90 mmHg)
• Shock(inadequate tissue perfusion)
• Altered mental status
• Ischemic chest pain
• Acute pulmonary edema/heart failure

➡️Immediate synchronized cardioversion(100J)

Stable SVT:
1)modified Valsalva maneuver(1st line)
2)Adenosine 6 mg rapid IV push +20CC NS flush → if unsuccessful 12 mg rapid IV push.

3)Metoprolol 5mg IV direct slowly
4)Verapamil 5mg IV slowly direct

6)ACLS
✅Immediately do the following (ركز)
1)Confirm unresponsiveness(tap/shake the shoulders gently)
2)absent breathing or abnormal breathing(gasping)
3)no pulse → start CPR immediately

• Call for help
• Ambu bag mask ventilation + 100% O₂
•prepare monitor/defibrillator
• Establish IV access

✅High quality CPR
1)Compression rate: 100–120/min
2)Depth: ≥5 cm (2 inches)
3)Full chest recoil
4)Minimize interruptions
5)Change compressor every 2 min
6) compression to breathing rate 30:2

✅Check rhythm(اهم خطوة)
➡️Shockable: VF / pulseless VT or pulse VT(unstable)

Shock → CPR 2 min (ركز)→ rhythm check

If still VF/VT 🔥
Shock → CPR 2 min + Epinephrine(adrenaline) 1 mg with 9CC NS IV direct and Continue CPR and reassess rhythm every 2 min

If still refractory(القاضية)
Shock → CPR 2 min +Amiodarone or Lidocaine
A)Amiodarone amp: 300 mg(2amp) IVbolus → then 150 mg(1amp)

B)Lidocaine: 1–1.5 mg/kg

➡️Non-shockable:Asystole / PEA
Immediately start CPR 2 min +Epinephrine(adrenaline)1mg IV+9ccNS IV direct then can repeat it every 3–5 min

Search aggressively for reversible cause(كلش كلش كلش مهم) 5 Hs & 5 Ts
•Hypovolemia
•Hypoxia
•Hydrogen ion (acidosis)
•Hypo/hyperkalemia
•Hypothermia

•Tension pneumothorax
•Tamponade
•Toxins
•Thrombosis — pulmonary
•Thrombosis — coronary(MI)

✅Stable VT( there is pulse)➡️كيس د خالد اتهام العجيبة
Amiodarone 150 mg IV over 10 minutes
If VT recurs → repeat 150 mg over 10 minutes Then 1 mg/min IV infusion for the first 6 hours.

ACLS

⚠️adrenaline Should dilute with NS to avoid Severe vasoconstriction cause Ischemic brain death