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Acute Coronary Syndromes (CPG A0401)

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Stop

  • ACS may present with atypical or no pain

  • Request early AP/MEDEVAC if STEMI

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Assess

  • 12-lead ECG (within 10 minutes), if STEMI treat as per CPG A0408

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Antiplatelet

  • Aspirin 300 mg oral if not already administered

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Nitrates

  • GTN 600 mcg S/L if SBP > 100 mmHg
    OR

  • GTN 300 mcg S/L if no prev. admin, borderline BP or small (< 60 kg), elderly or frail Pts

  • Repeat 300 or 600 mcg S/L @ 5 minute intervals titrated to pain or side effects

  • GTN patch 50 mg (0.4 mg/hr)

    • Remove if BP < 100 mmHg

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Pain relief

  • Pain relief other than nitrates, Mx as per CPG A0501

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AP: Hypertension (SBP > 160 or DBP > 100)

  • GTN 300 mcg SL

  • Repeat 300 mcg @ 5/60 if hypertension persists

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General Mx

  • MX STEMI as CPG A0408

  • Mx Nausea and vomiting CPG A0701

  • Mx as LVF CPG A0406

  • Mx as inadequate perfusion CPG A0407

  • Mx arrhythmia as per CPG A0201, A0402, A0403, A0404

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Flow Chart

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