Hello. This is Nikhil Mallela. Yesterday, I was posted in the casualty from 8:00pm to 8:00am.

At 2:35am,  a 75 year old male came with the chief complaint of chest pain in the left side since two hours. The pain was dragging in nature and it was radiating to his left arm and his back. 

B.P - 140/100 mm of hg

Pulse - 68 beats per minute 

Temperature- Afebrile 

GRBS - 132mg/dl 

The patient is not a known hypertensive or a diabetic. 

There were no similar complaints in the past.

We took an ECG at 2:45am.  

There were ST segment elevations in the leads V3,V4,V5 and V6.

It is suggestive of a myocardial infarction in the anterolateral walls.

We administered the patient with 

                                                   TAB ECOSPORIN 300mg po stat 

                                                   TAB CLOPIDOGREL 325mg po stat 

                                                   TAB ATORVOSTATIN 100mg po stat.

PROCEDURE DONE TODAY : 

                                                     At around 8:00 am in the morning as I was about to leave the casualty, there was an emergency case of paracetamol poisoning. 

I got the opportunity to pass the Nasogastric tube.

THORY TOPIC LEARNED TODAY : 

As we have only treated the patient conservatively, I spent some time reading on the management of STEMI and when to go for a surgical intervention.

I also read about the mode of action of the drugs we prescribed to him today. 

ASPIRIN  - rapid inhibition of cyclooxygenase 1 inhibitor followed by reduction in thromboxaneA 2.

CLOPIDOGREL - inhibit ADP receptors and prevent platelet aggregation. 

I also read about the treatment of paracetamol poisoning - administration of N acetylcysteine

“There’s a 21 hour regimen based on the elevation of acetomenophen levels, which raise 4 hours after the intake of toxic doses of paracetamol which is 4gms”