Acute Coronary Syndrome

ACLS Certification Institutewww.aclscertification.com | 1-800-448-2078

Fast, Convenient and 100% Online ACLS Training and CertificationEarn Your ACLS in 1-2 Hours. Certify or Recertify Today!

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