Interprofessional care : Acute Coronary Syndrome

Interprofessional care

• Acute Coronary Syndrome
  • Initial interventions
    • 12-lead ECG
    • Upright position
    • Oxygen – keep O2 sat > 93%
    • IV access
    • Nitroglycerin (SL) and ASA (chewable)
    • Statin
    • Morphine
  • Ongoing monitoring
    • Treat dysrhythmias
    • Frequent vital sign monitoring
    • Bed rest/limited activity for 12–24 hours
  • UA or NSTEMI
    • Dual antiplatelet therapy and heparin
    • Cardiac catheterization with PCI once stable
  • NSTEMI
    • Reperfusion therapy
  • • • Emergent PCI
        • Treatment of choice for confirmed STEMI
        • Goal: 90 minutes from door to catheter laboratory
        • Balloon angioplasty + stent(s)
        • Many advantages over CABG
      • Thrombolytic therapy
        • Only for patients with a STEMI
          • Agencies that do not have cardiac catheterization resources
        • Given IV within 30 minutes of arrival to the ED
        • Patient selection critical
        • Draw blood and start 2–3 IV sites
        • Complete invasive procedures prior
        • Administer according to protocol
        • Monitor closely for signs of bleeding
        • Assess for signs of reperfusion
        • Return of ST segment to baseline best sign
      • IV heparin to prevent reocclusion
      • Coronary surgical revascularization
        • Failed medical management
        • Presence of left main coronary artery or three-vessel disease
        • Not a candidate for PCI (e.g., blockages are long or difficult to access)
        • Failed PCI with ongoing chest pain
        • History of diabetes mellitus, LV dysfunction, chronic kidney disease
      • Traditional coronary artery bypass graft (CABG) surgery
        • Requires sternotomy and cardiopulmonary bypass (CPB)
        • Uses arteries and veins for grafts
          • The internal mammary artery (IMA) is most common artery used for bypass graft
      • Radial Arterty Graft
        • Radial artery is another potential graft
          • Thick muscular artery that is prone to spasm
          • Perioperative calcium channel blockers and long-acting nitrates can control the spasms
          • Patency rates are not as good as IMA but better than saphenous veins