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Acute Coronary Syndrome Algorith in ACLS
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Acute Coronary Syndrome
ACLS Certification Institutewww.aclscertification.com | 1-800-448-2078
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certication institutewww.aclscertication.com
ACLS
Yes
No
2 Appropriate EMS care and hospital notification
6
4 12-Lead ECGInterpretation
5 ST Elevation or assumed new LBBB,strong suspicion for injury
ED Assessment (within 10 minof patient arrival)
3
1 Patient presentation suggests Ischemia or acute MI
Provide cardiac monitorAssess/support ABCsPrep for CPR and rapid defibrillation if neededIf no contrary indications, administer aspirin, nitroglycerin and morphine (if needed)Administer appropriate oxygen therapyPerform 12-Lead ECG: if ST elevation observed, notify receiving hospital, relay 12-Lead findings or transmit if possible; provide medical report on patientHospital should activate STEMI teamUse fibrinolytic checklist if fibrinolytic therapy is considered
Assess vital signs and oxygenation statusEstablish vascular accessPerform rapid focused history/physical examPerform/review fibrinolytic exclusion checklistPerform appropriate lab tests including: cardiac markers and coagulation studiesOrder portable chest x-rays (within 30 min of patient arrival)
13ST Depression or T-Wave Inversion,strong suspicion for Ischemia
Yes
9
8
14
17If patient has no evidence of Ischemia
or infarction by testing, discharge patientwith instructions to follow up or return/call 911
should symptoms reoccur
90 min
10 min
30 min
15 Patient develops 1 or moreof the following?
Abnormal findings ondiagnostic non-invasive imaging
or physicologic testing?
10
11
12 Admit to appropriate monitor unitReassess risk statusContinue heparin, ASA, and appropriate therapies as needed ACE inhibitor/ARB HMG CoA reductase inhibitor (statin therapy)(Not at high risk: cardiology to risk stratify)
Immediate ED TreatmentAdminister O2 at 4L/min, titrate to SPO2 >94%Administer Aspirin 16--325 mg (if not administered by EMS)Administer sublingual or spray NitroglycerinConsider IV Morphine if pain not relieved by Nitroglycerin(Assess for contraindications for all drug administrations)
_
High-risk unstable angina/non-ST elevation MI (UA/NSTEMI)
16
ST-Elevation MI (STEMI)
Start adjunctive therapies as neededDo not delay reperfusion
7 Onset of symptoms
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