A 76-Year-Old Woman With Abdominal Pain

Craig A. Goolsby, MD

Disclosures

October 02, 2017

Multiple treatments should be initiated for patients with either suspected or confirmed AMI. First, supportive care should be initiated. Supplemental oxygen with potential airway intervention should be considered. Due to the underlying ischemia, the patient’s tissues may benefit from improved blood oxygen content. Fluid resuscitation, improving cardiac parameters for patients with decompensated heart failure, broad-spectrum antibiotics, and liberal pain control should all be considered.[2]

Due to the high mortality of AMI, consultation with a vascular surgeon should be obtained early, often before obtaining definitive diagnostic testing.[1,2] Definitive treatment options are numerous and depend on the type of AMI present. Options include papaverine infusion in NOMI, surgical embolectomy, intra-arterial thrombolysis, bypass grafting, stenting, anticoagulation, and--in NOMI (ie, no pressors, maximized cardiac function)--medically optimizing the patient’s vascular flow.[1,2] Treatment choices will vary depending on the underlying cause of the AMI and the preferences of the consulting vascular surgeons and interventional radiologists involved in the patient’s care.

Patients diagnosed with AMI must be admitted to the hospital, probably to an intensive care unit (ICU) or directly to an operating room or angiography suite (when indicated). Aggressive medical optimization in the ED setting is warranted, pending definitive treatment.

In the above case, a vascular surgeon was called, based on the patient’s clinical presentation. The CT angiography was obtained while the vascular surgeon traveled to the hospital. After review of the test results and the patient’s clinical appearance, the patient was admitted to the hospital for anticipated intra-arterial thrombolysis and further supportive critical care.

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