00:00
So there's some
other general test.
00:02
These are things that
might be considered
depending on what's going on
with this particular patient.
00:06
So additional test the team
might consider the ABG's
arterial blood gases.
00:12
Now the patient's awake alert
the same there's anything
indicating to be another problem.
00:17
These may not be done.
00:19
But the make consider ABG's
a comprehensive metabolic panel
or a basic metabolic panel.
00:25
The comprehensive panel is
going to have far more on it
than just a basic
metabolic panel.
00:30
Could look at
electrolytes and a CBC.
00:34
Now CBC is a
complete blood count
because we're looking for things
like an anemia or polycythemia.
00:41
So either low or
high red blood cells
because these could be
indications of some ongoing
impaired oxygen carrying
ability of the blood
if have chronic
problems the patient
may or may not be aware of it.
00:53
Sometimes when the patient
has had low oxygenation
for a long period of time
the body will try to compromise
by elevating those red cells.
01:02
Some other underlying issues.
01:04
So it's always a good
idea for a CBC to be run.
01:08
Now they'll be an inflammatory
response to infarcted tissue.
01:11
So if there is dead tissue,
you will see a response
or a change in the CBC
as evidenced by an
inflammatory response.
01:19
So look at the leucocyte count,
anticipate an increase within
a couple hours of the event
and a peak within
two to four days.
01:27
Does that mean the
patient has an infection?
No, it's part of of the
inflammatory response.
01:32
That's why it's really
important you understand
how to look at the results
of a CBC and a differential.
01:39
Now the leucocyte count
may remain elevated
because likely the inflammatory
process will remain ongoing
for a couple weeks.
01:46
So look at the leucocyte count
the white cell count
expect an increase within
two hours because of the MI
expected to peak within
the first two to four days
and it may stay elevated for
the first couple of weeks.
01:59
The hypergycemia
we want to watch
in all patients after an MI
because due to the
stress response
and the increased release
of catecholamines,
we expect that blood
sugar might tend to rise
and we know that
elevated glucose
is associated with
increased complications
and poor outcomes after an MI.
02:18
So whether the patient
is diabetic or not
keep an eye on their blood sugar
because we know that
that's usually a sign
that they're going to have
increased complications
and poor outcomes.
02:28
So we try to keep really
good blood sugar control
to maintain it within
the normal limits.
02:34
Electrolytes after an MI
can also be different.
02:38
There's a release of epinephrine
in that stress response
and it causes a rapid
influx of these electrolytes
out of the bloodstream
and into the cells.
02:47
So you're thinking after an MI
got epinephrine catecholamine.
02:51
It's going to cause the response
where these two rapidly and fuse
out of the bloodstream
and into the cell.
02:58
Now when they go into the cell
If I drew lab work,
these levels will be lower
we're talking about things like
potassium, magnesium and calcium.
03:08
Now elevated calcium
inside the cell
damages the membrane.
03:12
So as its rushing inside
the cell because of
right, the release of epinephrine
in the stress response.
03:18
It's going to damage
the membranes integrity
and in a packs its ability
for the heart to contract.
03:24
That's not a good deal.
03:25
So this mess with our
electrolytes is going
to impact the heart's
ability to contract.
03:31
On the electrical level because
of the shift of calcium.
03:34
Low sodium, you have to
watch for fluid volume status
because hyponatremia
may be dilutional and a sign
of fluid volume overload.
03:43
Okay so we're thinking
about electrolytes.
03:45
You're going to see
these on your BMP
whether it's the comprehensive
or the basic one.
03:50
These will be there.
03:51
So we're talking about
the impact of epinephrine
because it's released
in that stress response
the body feels like
it's under attack
because the heart is taken a hit
potassium, magnesium and calcium
are going to rush into the cell.
04:05
Now elevated calcium
inside the cell
can really damage them even more
and it impacts the ability
of the heart to contract.
04:13
So I've got the
heart that's damaged
maybe in the wall from
the infarcted tissue
and it's going to impact its
ability to be able to contract
due to the calcium shift.
04:23
Now low-sodium.
04:25
We talked about that once
but I wanted to come
back around to these
because a lot of us are
intimidated by electrolytes,
but there's no
reason for you to be
there's always a very
logical rationale
to why they're moving the
direction they're moving.
04:38
So if you want to pause a minute
as we're walking through this
just review these in
your head to make sure
that it's clear before
you keep moving with us.
04:46
That's great in a really good
investment in your own brain.
04:50
Now sodium,
low sodium is called hyponatremia.
04:55
So this can be an indication
of fluid volume status to
because if it's
delutional hyponatremia
that may be a sign that the
patient is fluid volume overloaded.
05:05
Well,
so what why is that a problem?
That's a problem
because fluid volume
overload might be a sign
that the heart can't
pump efficiently enough
to handle the amount of
volume that's on board.
05:19
So we're going to keep a really
close eye on those electrolytes.
05:24
Now C-reactive
protein is a marker
that tells us when there's
inflammation present
when there's inflammation
present, CRP is elevated
and we know that inflammation
plays a role in all of this
and the healing process
and it may predict a risk for
additional plaque formation
and acute coronary syndrome.
05:44
Now why is that?
Well we go into detail
on some of our other video
information about that.
05:48
So be sure to check those
but for now keep in mind
atherosclerosis that
inflammatory process kind
of a chronic
inflammatory process.
05:57
So this may be an indicator
not just of what's going on
now in the body after
the heart attack,
but it could be an
indication of what's
chronically going on in the body
and the risk for
atherosclerosis.
06:10
Now erythrocyte
sedimentation rate.
06:12
This increases levels with
inflammation and with MI,
so we would anticipate
if the patients had an MI
we would see this rise.
06:20
Remember it's also elevated
inflammation without an MI
it elevates within a few days
and it might remain
elevated for a few weeks.
06:29
So if the patient
has had an MI.
06:31
I would expect to see
this level elevated
may take a few days
after the event
and we'll probably hang
out there for a few weeks.
06:39
So these may be some test that you
wouldn't necessarily think about
but you can see how each
one of them plays a role
and putting a piece
together in the puzzle
of evaluating a
patient with an MI.