Table 1

ACS Initial interventions for ALL patients Contraindications

ECG w/in 10 min, repeat e/ 10-15 min

STEMI: ≥1 mm elevation in 2 contiguous

leads (≥2mm in V2 and V3) or new LBBB

Airway, breathing, circulation

Cardiac and O2% sat monitors, Maintain

O2% sat >90%, IV access

Aspirin 325 mg (non enteric) chew &

swallow

Measure Troponin, electrolytes, /Hb

3 sublingual nitroglycerin tablets, one e/5 RV infarct, phosphodiesterase use,

min hypotension

Metoprolol Signs of HF, bradycardia, severe reactive

airway disease, hypotension

Atorvastatin

Select one PCI Fibrinolysis: No reperfusion

tenecteplase,
alteplase,
streptokinase
Indications Within 120 min of If PCI unavailable —
FMC. May give w/in 120 min of
even >12 hrs FMC, sympt <12
hrs, no CI

Antiplatelet for all Ticagrelor or Clopidogrel Ticagrelor

prasugrel

Anticoag for all UFH Enoxaparin (for ↓ Enoxaparin or UFH

🩸 risk) or
Fondaparinux (for ↑
🩸 risk)