ACLS Acute Coronary Syndrome Algorithm

1. Assess patient for symptoms of acute coronary syndrome (ACS)

• Crushing chest pain
• Pain radiates to jaw, arm, back
• Nausea/vomiting
• Sweating
• Shortness of breath

2. Rapid sequence of interventions and additional assessments

• If no aspirin allergies, administer aspirin (patient should chew)
• If no contraindications, administer nitroglycerin
• Administer morphine, if needed
• Obtain 12-lead ECG
• Apply oxygen via nasal cannula if O2 <94%

3. Trained professional should assess ECG; ST-segment elevation myocardial infarction (STEMI)

STEMI

• Complete fibrinolytic checklist
• Determine precise onset of symptoms, if possible
• Initiate Fibrinolysis/PCI protocol immediately
• Antiplatelet therapy
  • Aspirin
  • Platelet P2Y12 receptor blocker
  • GP IIb/IIIa inhibitor (If destined for PCI)
  • Anticoagulation
  • Consider intravenous nitrates
  • Consider morphine
  • Beta-blockers (if no contraindications)
  • Statin therapy

Non-ST elevation ACS  (unstable angina or non-ST elevation myocardial infarction (NSTEMI))

• Antiplatelet therapy
  • Aspirin
  • Platelet P2Y12 receptor blocker
  • Anticoagulation
  • Admit to monitored bed
  • Consult Cardiology