Scribd
Upload
4K views1 page

Algorithm-ACLS ACS 200806 1

Uploaded by

Kavya Shree
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
4K views1 page

Algorithm-ACLS ACS 200806 1

Uploaded by

Kavya Shree
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Acute Coronary Syndromes Algorithm

Symptoms suggestive of ischemia or infarction

EMS assessment and care and hospital preparation


• Assess ABCs. Be prepared to provide CPR and defibrillation
• Administer aspirin and consider oxygen, nitroglycerin, and morphine if needed
• Obtain 12-lead ECG; if ST elevation:
– Notify receiving hospital with transmission or interpretation; note time of onset and first
medical contact
• Provide prehospital notification; on arrival, transport to ED/cath lab per protocol
• Notified hospital should mobilize resources to respond to STEMI
• If considering prehospital fibrinolysis, use fibrinolytic checklist

Concurrent ED/cath lab assessment Immediate ED/cath lab general treatment


(<10 minutes) • If O2 sat <90%, start oxygen at 4 L/min, titrate
• Activate STEMI team upon EMS notification • Aspirin 162 to 325 mg (if not given by EMS)
• Assess ABCs; give oxygen if needed • Nitroglycerin sublingual or translingual
• Establish IV access • Morphine IV if discomfort not relieved by
• Perform brief, targeted history, physical exam nitroglycerin
• Review/complete fibrinolytic checklist; • Consider administration of P2Y12 inhibitors
check contraindications
• Obtain initial cardiac marker levels, complete
blood counts, and coagulation studies
• Obtain portable chest x-ray (<30 minutes);
do not delay transport to the cath lab

ECG interpretation

ST elevation or new or Non–ST-elevation ACS (NSTE-ACS)


presumably new LBBB; Determine risk using validated
strongly suspicious for injury score (ie, TIMI or GRACE)
ST-elevation MI (STEMI)

ST depression or dynamic T-wave Normal ECG or nondiagnostic


• Start adjunctive therapies inversion, transient ST elevation; changes in ST segment or T wave;
as indicated strongly suspicious for ischemia low-risk score
• Do not delay reperfusion and/or high-risk score Low-/intermediate-risk NSTE-ACS
High-risk NSTE-ACS

>12
hours Troponin elevated or high-risk patient Consider admission to
Time from onset of
Consider early invasive strategy if: ED chest pain unit or to
symptoms ≤12 hours?
• Refractory ischemic chest discomfort appropriate bed for
• Recurrent/persistent ST deviation further monitoring and
≤12 hours • Ventricular tachycardia possible intervention
• Hemodynamic instability
• Signs of heart failure
Reperfusion goals: Start adjunctive therapies
Therapy defined by patient and (eg, nitroglycerin, heparin) as indicated
center criteria
See AHA/ACC NSTE-ACS Guidelines
• FMC–to–balloon inflation
(PCI) goal of ≤90 minutes
• Door-to-needle (fibrinolysis)
goal of 30 minutes
© 2020 American Heart Association

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy