Sandbox Rim: Difference between revisions
Rim Halaby (talk | contribs) |
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::❑ Maintenance dose 0.15 mcg/kg/min </div>}} | ::❑ Maintenance dose 0.15 mcg/kg/min </div>}} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | |!| | | |!| | | |!| | }} | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | |!| | | |!| | | |!| | }} | ||
{{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | F01 | | F02 | | F03 | |F01=<div style="float: left; text-align: left; width: 25em; padding:1em;"> '''Consider urgent [[CABG|<span style="color:white;">CABG</span>]] if the coronary anatomy is not amenable to PCI and one of the following:'''<ref name="www.ncbi.nlm.nih.gov">{{Cite web | last = | first = | title = ACC/AHA 2004 guideline update for coronary arter... [Circulation. 2004] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed?term=15466654 | publisher = | date = | accessdate = }}</ref> <br> ❑ Patients with left main or left main equivalent disease <br> ❑ Patients with three or two vessel disease involving the left anterior descending artery with left ventricular dysfunction <br> ❑ Diabetic patients </div>|F02=<div style="float: left; text-align: left; width: 25em; padding:1em;"> ❑ Perform an [[angiography|<span style="color:white;">angiography</span>]] </div>|F03= | {{familytree |boxstyle=background: #FA8072; color: #F8F8FF; | F01 | | F02 | | F03 | |F01=<div style="float: left; text-align: left; width: 25em; padding:1em;"> '''Consider urgent [[CABG|<span style="color:white;">CABG</span>]] if the coronary anatomy is not amenable to PCI and one of the following:'''<ref name="www.ncbi.nlm.nih.gov">{{Cite web | last = | first = | title = ACC/AHA 2004 guideline update for coronary arter... [Circulation. 2004] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed?term=15466654 | publisher = | date = | accessdate = }}</ref> <br> ❑ Patients with left main or left main equivalent disease <br> ❑ Patients with three or two vessel disease involving the left anterior descending artery with left ventricular dysfunction <br> ❑ Diabetic patients </div>|F02=<div style="float: left; text-align: left; width: 25em; padding:1em;"> ❑ Perform an [[angiography|<span style="color:white;">angiography</span>]] </div>|F03={{fontcolor|#000000|'''[[Unstable angina/ NSTEMI resident survival guide#Complete Diagnostic Approach|Continue with the complete diagnostic approach below]]''' }}|boxstyle_F03= background-color: #FFFFFF}} | ||
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Revision as of 21:38, 6 April 2015
FIRE: Focused Initial Rapid Evaluation
A Focused Initial Rapid Evaluation (FIRE) should be performed to identify patients in need of immediate intervention.
Boxes in the red color signify that an urgent management is needed.
Identify cardinal findings of unstable angina/ NSTEMI : ❑ Chest pain or chest discomfort
lightheadedness
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Rule out life threatening alternative diagnoses: ❑ Aortic dissection (suggestive findings: vomiting, subcutaneous emphysema) | |||||||||||||||||||||||
Begin initial treatment: ❑ Administer aspirin
❑ Administer 2-4 L/min oxygen via nasal cannula when saturation <90%
❑ Administer beta-blockers (unless contraindicated) and titrate to the heart rate and blood pressure
❑ Administer sublingual nitroglycerin 0.4 mg every 5 minutes for a total of 3 doses
❑ Administer 80 mg atorvastatin | |||||||||||||||||||||||
Does the patient have any of the following indications that require immediate angiography and revascularization ?
❑ Hemodynamic instability or cardiogenic shock | |||||||||||||||||||||||
YES | NO | ||||||||||||||||||||||
Does the patient have negative ECG findings AND negative biomarkers? | |||||||||||||||||||||||
Yes | No | ||||||||||||||||||||||
Repeat ECG and biomarkers within next 6 hours and 12 hours | |||||||||||||||||||||||
ECG and biomarkers are both negative | At least one (ECG or biomarkers) is positive | ||||||||||||||||||||||
Proceed to complete diagnostic approach of chest pain to rule out differential diagnoses | Calculate the risk of future adverse clinical outcomes: ❑ Thrombolysis in Myocardial Infarction (TIMI) risk score, OR ❑ GRACE score | ||||||||||||||||||||||
Proceed to angiography | High risk Initial invasive strategy | Low risk Initial conservative strategy | |||||||||||||||||||||
Administer ONE of the following antiplatelet agents (before or at the time of PCI):
Prasugrel is contraindicated in case of prior history of strokes or TIAs, active pathological bleeding, age ≥75 years, when urgent coronary artery bypass graft surgery (CABG) is likely, body weight <60 kg, propensity to bleed, concomitant use of medications that increase the risk of bleeding
Administer ONE of the following anticoagulant therapy:
| Administer one of the following antiplatelet agents: Before PCI
❑ IV GP IIb/IIIa inhibitors
At the time of PCI
❑ IV GP IIb/IIIa inhibitors
| Administer one of the following antiplatelet agents:
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❑ Perform an angiography | Continue with the complete diagnostic approach below | ||||||||||||||||||||||