[Prehospital treatment of acute myocardial infarction]

Mortality from acute myocardial infarction is high. The pre-hospital phase is particularly important, because it involves a high risk for the patient. Cardiac arrest is not uncommon. Other arrhythmias may arise, or reduced left ventricular function may induce pulmonary oedema or cardiogenic shock. The patient should therefore be transported to hospital as soon as possible, and should be given morphine and oxygen. Several therapeutic principles reduce mortality from acute myocardial infarction. Nitrates and acetylsalicylic acid can be administered before transport to hospital. Nitrates, intravenous diuretics, morphine and oxygen are important for treating pulmonary oedema, and should be administered as soon as possible. If equipment and expertise are available, a diagnosis of ventricular fibrillation or tachycardia can be verified and defibrillation performed. Intravenous atropine should be tried in cases of bradycardia. Thrombolytic therapy represents a challenge, because early start of the treatment is essential in order to salvage threatened myocardium. Optimal treatment depends on quick transport to hospital, information to the hospital, and effective routines i hospital itself.