ECGs in Acute Myocardial Infarction 

Diagnosing an acute myocardial infarction by ECG is an important skill for healthcare professionals, mostly because of the stakes
involved for the patient. One of the complications with using ECG for myocardial infarction diagnosis is that it is sometimes difficult
to determine which changes are new and which are old. For the purposes of this learning module, we will assume that all changes
are new for the patient and thus represent an acute myocardial infarction.

comparing the patient’s current ECG with an old ECG is an important part of diagnosis. On the other hand, particularly worrisome
changes by ECG should still be treated presumptively if the prior ECG is not available.

Where is the ischemic lesion?

A 12-lead ECG can be used to determine the coronary artery that is most likely affected by an ischemic event. Leads II, III, and aVF
provide a view of the right coronary artery, for example. Primary changes on ECG involving these three leads suggests a problem
in the right coronary. On the other hand, leads I, aVL, and V1 through V6 provide information about the left coronary artery.
Experienced users can analyze the ECG tracing to localize damage to specific areas of the heart. The inferior wall of the heart is
likely compromised when there are active changes in leads II, III, and aVF. Abnormalities in leads V3 and V4 are suggestive of a
problem in the anterior wall of the heart. Leads V1 and V2 provide information about the cardiac septum.
For each set of active changes e.g., J point elevation, there will be reciprocal changes in the complementary leads, which are
opposite the affected area. For example, an active change in leads V3 and V4, suggesting a problem in the left anterior descending
artery and affecting the ventricular septum, would be expected to cause reciprocal changes in leads II, III, and aVF.

A mechanical ventilator functions to provide gas exchange for a patient until they are self-sufficient. As Respiratory
Therapists, we often spend a lot of time focusing on the ventilator modes, settings, and initiation.
But, what about mechanical ventilator management?

Managing a patient while they are receiving ventilatory support is another very important aspect of mechanical
ventilation. Hopefully, this study guide can help make the learning process easier for you. So, if you’re ready, let’s
get started.
 Improving Oxygenation:
In order to improve a patient’s oxygenation status during mechanical ventilation, you can consider the following:

o Increase the FiO2

o Improve the patient’s ventilatory status
o Improve circulation
o Initiate CPAP
o Initiate PEEP
o Consider Airway Pressure Release Ventilation (APRV)
o Consider Inverse Ratio Ventilation (IRV)
o Consider prone positioning
Of course, other strategies may be used to improve the oxygenation parameters. These are just a few examples.

Improving Ventilation:
In order to improve a patient’s ventilation status during mechanical ventilation, you can consider the following:
o Increase the frequency setting
o Increase the tidal volume setting
o Reduce mechanical deadspace
Again, other strategies may be used to improve the ventilatory parameters. These are just some of the most
common examples.
In severe cases of inadequate oxygenation and/or ventilation, Extracorporeal Membrane Oxygenation
(ECMO) may be indicated. This process involved pumping the blood outside of the body through a machine so that
gas exchange can occur.
 Responding to Ventilator Alarms
A ventilator alarm is an alert that is designed to let the medical professional know when something is going on with the patient.

During mechanical ventilation management, a Respiratory Therapist must know how to respond to each of the different types
of ventilator alarms. To learn more, check out our full guide on this topic.

Other Considerations During Ventilator Management:

While managing a patient on a ventilator, here are some other considerations that should be made while ventilatory
support is being provided:

o Arterial Blood Gases (ABGs)

o Ventilator circuit management
o Artificial airway care and management
o Humidification therapy
o Ventilator-Associated Pneumonia prevention
o Nutrition
o Fluid balance
o Electrolyte balance
Each patient is different, therefore, other management considerations may be required depending on their condition.
These were just a few of the most common examples.