Acute coronary syndrome resident survival guide: Difference between revisions

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==Patient Presentation==
Acute coronary syndrome (ACS) refers to any group of symptoms attributed to obstruction of the coronary arteries.  Acute coronary syndrome may refer to either unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), or ST elevation myocardial infarction (STEMI).
The patient will most commonly present some or all of the following symptoms;
*Substernal/precordial chest pressure/heaviness/pain
*Pain in the shoulder or arm
*[[Nausea]] and/or [[vomiting]]
*[[Shortness of breath]]
*[[Diaphoresis]]
*Complaints of "[[heartburn]]"
*[[Dizziness]]
*[[Palpitations]]


==Initial Evaluation and Orders==
'''[[NSTEMI resident survival guide|Click here for NSTEMI/UA resident survival guide]]'''
* Ensure patency of airway, check for adequate breathing and circulation.
 
* Vital signs ([[Heart rate]], [[blood pressure]], [[respiratory rate]], [[temperature]], [[oxygen saturation]])
'''[[STEMI resident survival guide|Click here for STEMI resident survival guide]]'''
* [[EKG|12-lead EKG]] (compare with old EKG if possible)
* [[Cardiac enzymes]] (three sets of [[troponin]], [[CK]], [[CK-MB]] at six hour intervals; first set may be normal, but order all three sets)
* [[Chest x-ray]]
* [[Oxygen]] (titrate for oxygen saturation levels >92%)
* IV access
* 325mg non-enteric coated [[aspirin]] by mouth (or per rectum if patient cannot take orally)
* If patient is not hypotensive and inferior myocardial ifarction has been ruled out by EKG, give 0.4mg [[nitroglycerin]] sublingually up to three times, at 5 minute intervals, until chest pain improves.

Latest revision as of 17:22, 15 April 2015

Acute coronary syndrome (ACS) refers to any group of symptoms attributed to obstruction of the coronary arteries. Acute coronary syndrome may refer to either unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), or ST elevation myocardial infarction (STEMI).

Click here for NSTEMI/UA resident survival guide

Click here for STEMI resident survival guide

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