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
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- 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
- Only for patients with a STEMI
- 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
- Radial artery is another potential graft
- Emergent PCI
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- Initial interventions
