ACLS review: Acute Coronary Syndromes Part 1

Acute Coronary Syndromes

Primary goals of therapy for patients with ACS

·         Reduce the amount of myocardial necrosis

·         Prevent major adverse cardiac events

·         Treat acute, life-threatening complications of ACS

AMI Symptoms

·         Pain that is more intense than angina and that persists for longer periods of time (eg, longer than 15–20 minutes)

·         Chest discomfort, discomfort in other areas of the upper body, shortness of breath, sweating, nausea, vomiting, and dizziness

·         Atypical symptoms are more common in women, the elderly and diabetic patients.

Initial Evaluation

·         Obtain vital signs and oxygen saturation

·         Obtain IV access

·         Obtain 12 lead EKG

·         Perform target history

·         Obtain serum cardiac enzymes, CBC chemistries, and coagulation studies

·         Portable CXR

Note:  Ideally within 10 minutes of ED arrival providers should obtain a targeted history while a monitor is attached to the patient and a 12-lead ECG is obtained (if not done in the prehospital setting). The evaluation should focus on chest discomfort, associated signs and symptoms, prior cardiac history, risk factors for ACS, and historical features that may preclude the use of fibrinolytics or other therapies

Initial General Treatment
(MONA greets all patients)

·         Morphine 2-4mg IV if pain unrelieved by nitroglycerine

·         Oxygen 4L/min

·         Nitroglycerine SL or spray

·         Aspirin 160-325mg