Thrombolytic

(Giving Streptase 1.5 million units) 

Chest paint IMA > 20 ', retrosternal middle / left chest, radiating to jaw, back, left arm sepereti depressed heavy objects, crumpled like burning or tingling, can be pain in the epigastrium, cold sweat, nausea, vomiting, weakness , dizziness, floating, unconscious 

 WHO criteria for AMI 

- Chest pain typical 

- Evaluation of ECG 

- There was an increase and then decrease in cardiac enzymes 

- Hyperacute T, ST evaluation, T-inverted 

ST evaluation of at least 0.1 mm in 2 contiguous sandapan 

- BBB newly considered IMA 

- Old infarction: QR V1 - V2> 0.035 

Q I, II, aVL, aVF, V4 - V6 at least 1 mm 

- Inferior infarction, suspected myocardial post 'N right ventricle 

Check V3R - V4R and V7 - V9 

 Indications Streptase

- Acute myocardial infarct (no more than 12 hours) with ST evaluation or LBBB 

- DVT (no more than 14 days) 

- Acute massive pulmonary embolism 

- Chronic arterial blockage (no more than 6 weeks) 

- Acute and subacut thrombosis of peripheral arteries 

 Streptase 1.5 million can not be used for having an allergic reaction to the product caused the risk of bleeding during therapy given streptase 1.5 million so it can not be given in the conditions: 

- Active internal bleeding (2-4 last week) 

- Hemorrhagic stroke 

- Bleeding intracranial or intraspinal (spinal cord surgery) 

- Intracranial tumors 

- Trauma to the head, a new trauma within 2-4 weeks 

- Aneurysm 

- Neoplasm with the risk of bleeding 

- Acute pancreatitis 

- Hypertension with systolic pressure over 200 mmHg and or diastolic pressure over 100 mmHg 

- In the treatment of oral anticoagulation (INR> 1.3) 

- Acute liver disease or kidney disease 

- Endocarditis, or pericarditis 

- Post major surgery (less than 3 weeks) 

- The use of streptokinase (<2 years) 

- History streptokinase allergy 

- Pregnant 

- Gastritis 

 Investigations 

- Check CKMB started 4-8 hours 

- Check triponin from 4-8 hours to 14 days repeated 12-24 hours later 

 Giving 

1. Put IVline with venflon no. 20 

2. Before the injection is given streptase given anti-allergy: dexametasone inj 

3. Streptase 1.5 million units given intravenously, is given when BP> 100 mm Hg in 100 cc DS% / NaCl 0.9% finished in 1 hour 

4. During the granting watch KU, tension, pulse, ECG, arrhythmias, bleeding and allergy patient complaints 

5. Observations in every 5 minutes during the administration streptase 

6. When the tension down, loading the Nacl, observation and pulse tension 

7. Prepare medications such as dopamine, vascon and defibrillators 

8. Observations EKG rhythm: VT, SVT 

9. After 1 hour administration streptase carried out repeated ECG 

10. Check CKMB enzyme, triponin I, AST / LDL 1 h post streptase 

11. After 6 hours given heparin 5000 iu bolus followed 100 units / hour 

12. 1 hour after administration of heparin, check APTI target of 1 ½ - 2 times the control