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Acute Coronary Syndrome PDF
Acute Coronary Syndrome PDF
http://www.nejm.org/doi/full/10.1056/NEJMra1216063
Sign & Symtoms
Normal ECG
Acute Coronary Syndrome
Cardiac Enzim
CKMB
Troponin
Lokasi Infark
Septal: V1 V2
Anterior : V3 V4
Lateral: I, AvL, V5, V6
Inferior: II, III, AvF
Posterior: V7 V8 V9
Right Lead ECG
Bagaimana memasang sadapan
posterior ??
Lakukan
pemasangan
sadapan posterior
(V7, V8, V9) jika
ditemukan ST
Depresi pada V1 -
V3
elevasi ST 0,5 mm
pada V7 - V9
Location
LeftCoronary
Artery:
LCX: Lateral
LAD: Anteroseptal
Right Coronary
Artery:
Main: RVI, Post, Inf
LDP: inferior
Acute Coronary Syndrome
Chest Pain
ECG Changes
Yes No
Prehospital
Rumah sakit
IGD
Perawatan lanjut
Prehospital Management of Acute
coronary Syndrome
EMS Triage &
Early
Assessment Hospital
Recognition
& Care Destination
Prehospital ECG
Fibrinolitic
Cheklist
Improving System Care of Acute
Coronary Syndrome
Sanford Health
Early Recognition of ACS
Focused History and Physical Exam
Chest discomfort
Don’t
Spread to Arms, Soulders, neck, Forget
jaw, back, or upper abdomen
Shortness of breath
Nausea
Lightheadedness
Call for Help
911
Notify Hospital
Prehospital Triage & Hospital
Destination
Direct triage from the scene to a PCI capable hospital
may reduce the time to definitive therapy and improve
outcome
Mortality rate ACS Patient was significantly reduced
(8.9% versus 1.9%) when transport time was less than 30
minutes.
Fibrinolytic therapy is recommended if patient arrived in
2 hours since sign and symptoms are appear
Stroke
Ada riwayat trauma mayor/bedah/luka kepala
dalam 3 minggu
Perdarahan Gastro Intestinal dalam 1 bulan
terakhir
Kelainan darah
Dissecting aneurisma
Kontraindikasi relatif
Syok kardiogenik
Cardiac arrest
Gagal jantung
Ruptur muskulus papilaris
Aritmia
Edukasi pada saat pemulangan
Cemas
Merubah kebiasaan buruk
Terapi antiplatelet: aspirin 165 mg PO /
hari
Case presentation
Case Presentation