Acute Coronary Syndrome (ACS)

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Acute coronary syndrome (ACS) is a set of clinical presentations that includes unstable angina, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMIA). Several symptoms give way to ACS, including: intense chest pain; uneven breaths; pain that extends to the jaw, arm, or shoulder; sweating; and/or nausea or vomiting. Remember that not all patients exhibit these findings, especially in women and people diagnosed with diabetes mellitus. It is impossible to define a cardiac event from ACS symptoms; therefore, ACS symptoms are managed in the same way.

Individuals exhibiting these symptoms should be studied and observed immediately. If you find yourself with an unconscious person, start with the BLS Survey and follow the right steps toward advanced health care. In the event that the patient is conscious, follow the steps below.

EMS
Oxygen

• Use four liters per minute nasal cannula; titrate as needed

Aspirin

• If no allergy, give 160 to 325 mg ASA to chew. Avoid coated ASA

Nitroglycerin

• Give 0.3 to 0.4 mg SL/spray x two doses at 3 to 5 minute intervals
• Do not use if SBP < 90 mmHg
• Do not use if phosphodiesterase inhibitor, like Viagra, taken within 24 hours

Morphine

• Give 1 to 5 mg IV only if symptoms not relieved by nitrates or if symptoms recur. Monitor blood pressure closely

12-Lead ECG

• Evaluate for MI: ST elevation or depression, and poor R wave progression

IV Access

• Large gauge IV in antecubital fossa

Notify Hospital

• Take to PCI center if probable STEMI
• Activate ACS protocol at hospital

Figure 41

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