Oxygen Therapy For
Patient With Acute Coronary Symptom
An acute coronary symptom is used as a general term to explain other diseases associated with a sudden decrease in blood flow to the heart. One of the conditions is myocardial infarction where there is cell death due to destroyed heart tissues. Decreased blood flow in the coronary artery inhibits the heart muscle to function well (Clagett P, 2015).
Abnormal accumulation of materials in the inner layer of the arterial wall causes formation if a thrombus which blocks the coronary artery. The materials include the macrophages, debris which has calcium, lipid, and fibrous connective tissue. These materials can either erupt or erode hence blocking the wall of arteries (Gomar, 2016).
The most common symptom is chest pain which starts from the left shoulder, on taking and recording ECG 30%percent of the symptom is ST-elevation myocardial infarction (STEMI) and 25% is non-ST-elevation myocardial infarction (non-STEMI).Many people with this present with signs and symptoms apart from the chest pain mostly women, elderly and patients with diabetes mellitus (R, 2015).
Oxygen supplementation is the standard interventions for those patients diagnosed with acute coronary syndrome including myocardial infarction and post-cardiac arrest patients in spite of their saturation levels of oxygen. Oxygen administration increases the amount of oxygen to hypoxic cells thus reducing the effects of hypoxia in these patients (Lang, 2015).
There are many guidelines which address oxygen administration to these patients. These guidelines have been changed and improved over the years. In 2004; the recommendation was for oxygen to be administered to those patients with ST-elevated myocardial infarction (STEMI) with saturation levels of less than 90%, it stated that it was important to administer oxygen to these patients during the first six hours but unfortunately there was no information on the amount of oxygen to be administered (Salamanca, 2017).
In 2014 American Heart Association on Acute Cardiac syndrome the guideline for taking care of patients with Non-ST elevated myocardial infarction (non-STEMI) gave recommendations of administering supplemental oxygen only to the patient with saturation levels of less than 90%. Those also with respiratory distress or increased risk of developing symptoms of hypoxemia (Helin, 2018).
In 2015 American Heart Association guideline update for Cardiopulmonary and Resuscitation and Emergency Cardiovascular care at least gave more and specific directions on oxygen therapy. Its review of the system noted observation studies which suggested that excess oxygen in arteries concentrations hyperopia defined at a partial pressure of oxygen being more than 300mmHg may adversely affect different organs or worsen its outcomes. These outcomes oxygen toxicity is divided into central nervous system toxicity and the cardinal signs are the presence of generalized tonic-clonic seizure, there is pulmonary and ocular toxicity whose signs and symptoms include; disorientation, myopia, irritation of trachea leading to persistent (Alessandra, 2018)
Cough, tightness of the chest causing dyspnea and difficulty in breathing. It was also noted that other studies never managed to confirm these findings. These guidelines defined a hypoxic state as oxygen saturation levels of less than 94% and it commented that it is very important to prevent the episodes of hypoxia than to avoid any risk that can be caused by hypoxia (Hyun, 2017).
The basis of recommendation was to utilize the highest oxygen concerned which was available up to the time the partial pressure of oxygen and saturation of oxyhemoglobin saturation can be quantified. The guideline also indicated that it is more important and knowledgeable to reduce FiO2 so long as it can be maintained at a rate if more than 94%.
The most known data concerning the use of oxygen is provided by Air Versus Oxygen Myocardial Infarction (AVOID) trial. They used a random controlled method of study which differentiated the outcomes of the supplementing oxygen 8l/min and those with no oxygen supplements in those with ST-elevated Myocardial Infarction (STEMI)and oxygen saturation of less or equal to 94% was taken using a pulse oximeter. The first result was measured by the use of troponin and cardiac enzyme assays while the second outcomes were relapsing myocardial infarction and cardiac arrhythmias. On monitoring, it was noted that statistics we’re favoring a no oxygen strategy (Salamanca, 2017).
In 2017 the Determination of the Role of Oxygen in Suspected Acute Myocardial Infarction (DETOX2X-MI) clinical study registered acute coronary syndrome patient who had oxygen saturation level of more than or equal to 90% to be administered with oxygen supplement and those who inhaled air. There was insignificant statistical variation in that whole year because there was a risk of death among the groups (Helin, 2018).
Mr. Herz
Maintain the oxygen levels of 6l/ min because the signs and symptoms are
not improving, during triage at accidents and emergency department the
respiration rate was 26 breaths per minute this indicated difficulty or pain
during breathing, and the chest pain had persisted for 40minutes. The capillary
refill was 2 seconds which was not normal. Even after the intervention, Mr.
Herz complained if severe central chest pain at 0200 and the 12 lead ECG on
repeat showed variations of ventricular bradycardia and tachycardia. Also, the
ST segment is elevated. Even though there was a reduction of CK, CKMB, and
troponin T after administration of reopro (abciximab) infusion the enzymes
we’re still far much from the normal ranges. For the six days in the hospital
ensure Mr. Herz oxygen levels is maintained at 6l/min while the oxygen
saturation is monitored, also checking any signs of oxygen toxicity in central
nervous system, pulmonary and ocular system. After doing the assessment and the
patient is stable you can wean off the oxygen and monitor the patient for 30
minutes for any changes.
An acute coronary syndrome is rare in children because they usually have either acute inflammatory condition of the coronial artery. Intrauterine myocardial infarction may occur especially due to a stenotic coronary artery. Heart disease emergencies are not common among the paediatrics and signs and symptoms mostly differ, this is because the coronaries are only rarely the main issue. The paediatric cardiac problem contains a wide range of pathology comprising undetected congenital heart disease, complications of congenital heart disease of a palliative child, arrhythmias due to cardiac pathology in children and acquired heart disease (Cannon C P, 2015).
Diseases that cause instructions of the coronary artery include lesions that occlude the left side of the heart, hypoplastic heart syndrome stenosis of the aortic artery, coarctation of the aorta these conditions cause hypoperfusion, circulatory collapse, shock difficulty in breathing, increased heart rate and features of hypoxia. Lesions obstructing the right side of the heart like tetralogy of Fallot and pulmonary atresia causes occlusion of the coronary arteries.
When managing a child with acute coronary syndrome short term and long-term interventions are implemented. The short term includes administration of oxygen by face mask at least 8l/min this increases delivery of oxygen to the ischemic tissues and reduces the episodes of shortness of breath. Relieving pain by administering painkillers like paracetamol and diclofenac, improving blood flow to restore heart function by performing cardiac catheterization. Medications like statins are used this has better outcome on patients suffering from congestive heart disease and low aspirin dose decreases the clotting of blood and increases blood flow. Other drugs include nitroglycerin and beta blockers. The doctor working on emergency room and pediatric intensivist is mostly been the primary and secondary providers of care for pediatric heart diseases emergencies hence it’s mandatory for them to be having the competence and knowledge on the different signs of cardiac conditions in for them to enhance the opportunity of giving immediate and appropriate intervention and referral. The main reason for this is to point out heart diseases emergencies among the children and show the difference from the clinical signs presented in adults (Alessandra, 2018).
Mika would have been supplemented with oxygen about 8l/min because of shortness of breath, capillary refill of 2seconds, and ST elevation in lead augmented vector and associated ST segment in leads II and III. ECG reading was varying it showed both periods of ventricular bradycardia and tachycardia. There was also augmentation of the vector foot (AVF). Due to these records from ECG Mika needed oxygen supply to reduce ischemic condition and the ST segments can change. Oxygen was important due to the mass observed on anterior leaflet of the mitral valve these could be am atheroma causing a coronary blockage.
References
Berny‐Lang, M. A., Darling, C. E., Frelinger III, A. L., Barnard, M. R., Smith, C. S., & Michelson, A. D. (2015). Do immature platelet levels in chest pain patients presenting to the emergency department aid in the diagnosis of acute coronary syndrome?. International journal of laboratory hematology, 37(1), 112-119
Callaway, C. W., Soar, J., Aibiki, M., Böttiger, B. W., Brooks, S. C., Deakin, C. D., … & Morrison, L. J. (2015). Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation, 132(16_suppl_1), S84-S145.
Cannon, C. P., Blazing, M. A., Giugliano, R. P., McCagg, A., White, J. A., Theroux, P., … & De Ferrari, G. M. (2015). Ezetimibe added to statin therapy after acute coronary syndromes. New England Journal of Medicine, 372(25), 2387-2397.
Miguel, J. A., Lechuga, Y., Allende, M. A., & Martinez, M. (2017, November). CCO-based analog front-end for iStents. In 2017 32nd Conference on Design of Circuits and Integrated Systems (DCIS) (pp. 1-6). IEEE.
Monsieurs, K. G., Nolan, J. P., Bossaert, L. L., Greif, R., Maconochie, I. K., Nikolaou, N. I., … & Zideman, D. A. (2015). European resuscitation council guidelines for resuscitation 2015 section 1. Executive summary. Resuscitation.-Limerick, 1972, currens, 95, 1-80.
Pelletier,
R., Ditto, B., & Pilote, L. (2015). A composite measure of gender and its
association with risk factors in patients with the premature acute coronary
syndrome. Psychosomatic Medicine, 77(5), 517-526.
Pelletier, R., Khan, N. A., Cox, J., Daskalopoulou, S. S., Eisenberg, M. J., Bacon, S. L., … & Norris, C. M. (2016). Sex versus gender-related characteristics: which predicts outcome after acute coronary syndrome in the young?. Journal of the American College of Cardiology, 67(2), 127-135.
Pfeffer, M. A., Claggett, B., Diaz, R., Dickstein, K., Gerstein, H. C., Køber, L. V., … & Maggioni, A. P. (2015). Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. New England Journal of Medicine, 373(23), 2247-2257.
Sabouhi, F., Maleki, M., Amini, M., & Kerdegari, M. (2015). Impacts of insulin infusion protocol on blood glucose level and outcomes in acute coronary syndrome patients with diabetes mellitus. Iranian journal of nursing and midwifery research, 20(3), 304.
Sanchis-Gomar, F., Perez-Quilis, C., Leischik, R., & Lucia, A. (2016). Epidemiology of coronary heart disease and acute coronary syndrome. Annals of translational medicine, 4(13).
Sarrato, G. Z., García, E. S., Maldonado, J. A., Robles, C. G., Lluch, M. T., Sanz, M. I., & Grupo de Reanimación Neonatal de la Sociedad Española de Neonatología. (2017). Changes in the international recommendations on neonatal stabilisation and resuscitation (2015). Anales de Pediatría (English Edition), 86(1), 51-e1.
Thompson, P. L. (2011). Coronary care manual. Elsevier Health Sciences.
