A patient has arrived at the emergency department with complaints of chest pain and is suspect-ed of having an acute myocardial infarction (AMI)
Review the following criteria, and select the one that should be used to determine whether this patient is a candidate for thrombolytic therapy.
a. Chest pain lasting 2-4 hours, ST-segment elevation of 0.1 mV in at least one ECG lead
b. Chest pain lasting 1-6 hours, ST-segment elevation of 0.1 mV in at least three contiguous ECG leads
c. Chest pain lasting 0.5-6 hours, ST-segment elevation of 0.1 mV in at least two contiguous ECG leads
d. Chest pain lasting 0.5-4 hours, ST-segment elevation of 0.1 mV in at least two contiguous ECG leads
ANS: C
The indications for use of a thrombolytic drug in treatment of an acute myocardial infarction are that the patient has chest pain consistent with an MI for at least 30 minutes, but not longer than 6 hours, and at least 0.1 mV of ST-segment elevation in at least two contiguous ECG leads. The ACC/AHA guidelines for treatment of ST-elevation MI note that prehospital thrombolytic ther-apy is reasonable if a physician is present in the ambulance, in well-organized EMS, and when transport times exceed 60 minutes.
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