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Cardiology
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Initial Stabilization of STEMI
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MONA-BASH plus PCI in 90 minutes (or thrombolytics in 120).
Decision
Outcome
Decision
STEMI diagnosed. Initial medical bundle?
✓
Aspirin 325 mg chewed + P2Y12 inhibitor + sublingual nitrate + β-blocker + high-dose statin + anticoagulation (± O₂ if SpO₂ <90%)
✗
Heparin alone
✗
Oxygen for everyone regardless of saturation
Decision
Symptom-specific adjuncts — which complication is present?
✓
Persistent pain, HTN, heart failure → IV nitroglycerin (avoid if hypotensive, RV infarct, severe AS)
✓
Persistent severe pain despite nitrates → IV morphine
✓
Unstable sinus bradycardia → IV atropine
✓
Pulmonary edema → IV furosemide (avoid if hypovolemic)
✓
None — proceed to reperfusion
Outcome
IV nitroglycerin
Avoid in inferior MI with RV involvement (preload-dependent) — give fluids instead.
Outcome
IV morphine 2–4 mg
Use cautiously — morphine may impair P2Y12 absorption.
Outcome
IV atropine 0.5 mg
Outcome
IV furosemide
Outcome
Reperfusion: PCI within 90 min preferred; thrombolytics if PCI not available in 120 min
Door-to-balloon ≤90 min. Door-to-needle ≤30 min if lytic chosen.
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