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ACLS Acute Coronary Syndrome Algorithm

14-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

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