Essential Acute Care Guidelines for ACS Patients
Zainab Bagus
What is the recommended initial dose of aspirin for ACS patients?
162–325 mg (non-enteric coated), chewed and swallowed.
What should be done after the initial dose of aspirin for ACS patients?
Continue with 81 mg daily indefinitely.
What are the contraindications for aspirin use?
Hypersensitivity and major GI intolerance.
Which medication should be used as an alternative to aspirin in case of contraindications?
Clopidogrel.
What is the indication for nitrates in ACS?
Relief of anginal symptoms, uncontrolled hypertension, and acute heart failure.
What is the initial dose of Isosorbide Dinitrate for angina?
5 mg sublingually, repeated every 5-10 minutes as needed (maximum of 3 doses).
When should intravenous NTG be considered for ACS?
For persistent angina despite sublingual NTG.
What is the recommended oxygen administration for ACS patients?
40% via facemask if saturation is < 94% or if in distress.
What current guidelines recommend for pain relief in STEMI/NSTEMI patients?
IV morphine.
What is the starting dose for IV morphine in ACS patients?
5 mg diluted with 10 mL of water or sodium chloride, slow IV.
When should beta blockers be administered to ACS patients?
Within the first 24 hours of presentation.
What is the target dose for Carvedilol in ACS patients?
25 mg orally twice daily as tolerated.
Which calcium channel blockers are recommended for angina symptoms in ACS patients?
Nondihydropyridine CCBs (diltiazem, verapamil).
What is the recommended daily dose range for Diltiazem in ACS patients?
120–360 mg/day orally.
What is the treatment of choice for STEMI within 90 minutes of first medical contact?
Primary PCI.
What are the benefits of primary PCI compared to fibrinolysis?
Improves survival, establishes consistent revascularization, reduces risk of stroke and re-infarction.
What is the dose for Streptokinase in STEMI treatment?
IV 1.5 million units diluted in 100 mL sodium chloride, infused over 30–60 minutes.
What are absolute contraindications for Streptokinase?
Previous allergy, CVA within last 3 months, active bleeding, recent major trauma, and others listed.
If Streptokinase is unavailable, what alternative treatment can be used?
Alteplase, IV infusion.
What is the loading dose for Enoxaparin after Alteplase administration?
IV, 30 mg as a bolus, followed by SC, 1 mg/kg as a single dose.
What is the starting rate for IV Glyceryl Trinitrate in ACS treatment?
5 mcg/minute, titrated to response.
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Description
Discover key recommendations for acute supportive care in Acute Coronary Syndrome (ACS), including aspirin, nitrates, oxygen, and morphine management to enhance patient outcomes and ensure effective treatment strategies.
Questions
Download Questions1. What is the initial dose of aspirin recommended for all ACS patients without contraindications?
2. For how long should aspirin 81 mg be continued after the initial dose in ACS patients?
3. What is the recommended treatment for ACS patients with hypersensitivity to aspirin?
4. What is the initial dose of intravenous nitroglycerin (IV NTG) for persistent angina despite sublingual NTG?
5. When should oxygen therapy be administered to ACS patients?
Study Notes
Acute Supportive Care in Acute Coronary Syndrome (ACS)
Acute Coronary Syndrome (ACS) requires timely and effective management strategies to prevent complications and improve patient outcomes. This overview consolidates essential treatments, including medications and their administration guidelines.
Importance of Medications in ACS
Aspirin
- Role: Essential for all ACS patients unless contraindicated; prevents blood clots.
- Dosage: Initial dose of 162-325 mg, chewed for quick absorption; maintenance dose of 81 mg daily indefinitely.
- Contraindications: Hypersensitivity or severe gastrointestinal issues may necessitate alternatives like clopidogrel.
Nitrates
- Use: Relieve angina, manage hypertension, and treat acute heart failure.
- Administration: Isosorbide dinitrate sublingually every 5-10 minutes; IV nitroglycerin if symptoms persist.
- Contraindications: Avoid use with recent phosphodiesterase-5 inhibitors.
Morphine
- Indication: Pain relief for STEMI/NSTEMI patients.
- Dosage Guidelines: Start with 5 mg IV, adjusting as needed; re-administer every 4 to 6 hours if pain persists.
- Monitoring: Watch for hypotension during treatment.
Additional Treatment Strategies
Beta Blockers
- Importance: Reduce angina and lower myocardial infarction risk.
- Administration Timing: Initiate within the first 24 hours post-presentation; continue long-term based on left ventricular ejection fraction (LVEF).
Calcium Channel Blockers (CCBs)
- Role: Manage angina but do not reduce mortality rates. Recommended when beta-blockers are contraindicated.
Treatment Strategies for STEMI
Primary PCI vs. Fibrinolysis
Primary PCI
- Preferred method for STEMI; must be performed within 90 minutes of contact.
- Benefits include improved survival rates and reduced complications compared to fibrinolysis.
Fibrinolysis
- Administer streptokinase within the first 6 hours of chest pain onset; monitor closely for allergic reactions and avoid heparin post-administration.
Key Takeaways
- Timely administration of aspirin is crucial in ACS management unless contraindicated.
- Nitrates are effective for angina relief but require careful monitoring due to potential interactions with other medications.
- Primary PCI is the preferred treatment modality for STEMI, significantly enhancing patient outcomes compared to fibrinolytic therapy.
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