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

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