Regional Emergency Medical Advisory Committee of New York City
Prehospital Advanced Life Support Protocols
Copyright January 1996 (12/96)

504 SUSPECTED MYOCARDIAL INFARCTION

  1. Begin Basic Life Support Chest Pain procedures.
  2. Begin Cardiac Monitoring, record and evaluate EKG strip.
  3. Begin an IV infusion of Normal Saline (0.9 NS) to keep vein open, or a Saline Lock.
  4. Monitor vital signs every 2-3 minutes.

Sub-Protocols

504-A Drug Therapy of Myocardial Ischemia

504-B Cardiogenic Shock

Go to the top of the page Go to the Index

504-A DRUG THERAPY OF MYOCARDIAL ISCHEMIA

  1. If chest pain persists, administer a Nitroglycerin Tablet 1/150 gr or Spray 0.4 mg, sublingually, every 5 minutes for a total of 3 doses. Before each administration, check the patient's pulse and blood pressure to ensure the patient is hemodynamically stable.

  2. If chest pain persists, apply Nitropaste 1.5 inches (if available).

    The paste version of nitroglycerin must not be confused with the "Nitro Patch." The patch form of the medication is designated as a chronic, sustained-release form of nitroglycerin; not for the acute management of chest pain.

  3. Administer one chewable Baby Aspirin Tablet, 81 mg.

  4. If chest pain or other evidence of myocardial ischemia still persists, contact Medical Control for implementation of one or more of the following MEDICAL CONTROL OPTIONS:

NOTE: NITROGLYCERIN AND NITROPASTE MAY NOT BE ADMINISTERED TO PATIENTS WITH A SYSTOLIC BLOOD PRESSURE OF LESS THAN 100 mm Hg, UNLESS AN IV/SALINE LOCK IS IN PLACE.

MEDICAL CONTROL OPTIONS:

OPTION A:Administer Morphine Sulfate 2.0-5.0 mg, IV/Saline Lock bolus. Repeat doses of Morphine Sulfate 2.0-5.0 mg IV/Saline Lock bolus, may be given as necessary. (Maximum total dosage is 15 mg.)
NOTE:
IF HYPOTENSION, HYPOVENTILATION, OR STUPOR DEVELOPS DURING ADMINISTRATION OF MORPHINE SULFATE, WITHHOLD MORPHINE SULFATE, ELEVATE THE LEGS, AND ADMINISTER NALOXONE 2.0 MG, IV/SALINE LOCK BOLUS.
OPTION B:Administer Lidocaine 1.5 mg/kg, IV/Saline Lock bolus. Repeat doses of Lidocaine 0.75 mg/kg, IV/Saline Lock bolus, may be given every 5 minutes, and may be followed by Lidocaine 1.0-4.0 mg/min, IV/Saline Lock drip. (Maximum individual dose is 1.5 mg/kg and maximum total dosage is 3.0 mg/kg.)
OPTION C:Repeat Nitroglycerin Tablet 1/150 gr. or Spray 0.4 mg, sublingually, every 5 minutes (if transport is delayed or extended).
OPTION D:Administer Magnesium Sulfate 2.0 gm, IV/Saline Lock drip, diluted in 50-100 ml of Normal Saline (0.9 NS) over 10-20 minutes.
OPTION E:Transportation decision.

Go to the top of the page Go to the Index

504-B CARDIOGENIC SHOCK

  1. Contact Medical Control for implementation of one or more of the following MEDICAL CONTROL OPTIONS:

MEDICAL CONTROL OPTIONS:

OPTION A:Administer Dopamine 5.0 ug/kg/min, IV/Saline Lock drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until the desired therapeutic effects are achieved or adverse effects appear. (Maximum dosage is 20 ug/kg/min, IV/Saline Lock drip.)
OPTION B:Transportation decision.

Go to the top of the page Go to the Index