Mx of ACS

Question 1

Initial steps in management of ACS (2 x mnemonics)

Answer 1

A B C D E approach if critically ill

M - morphine IV (+ metoclopramide IV)

O - oxygen (if sats below target 94%-98%)

N - nitrate

A - aspirin - loading dose 300mg; then 75mg

C - clopidogrel

Question 2

(2) STEMI on ECG and PCI available within 120 minutes?- YES

Answer 2

Gold standard - PCI

Question 3

Indications for PCI

Answer 3

Any ACS:

SEMI (any ST elevation or new LBBB)
NSTEMI
Unstable angina
Contraindications: significant comorbidities

*PCI is a gold standard Rx for ACS

Question 4

What drugs are given with PCI?

Answer 4

1. Bilvardin

2. LWM Heparin

Question 5

What is done if PCI is unsuccesful?

Answer 5

CABG

Question 6

(2) STEMI on ECG and PCI available within 120 minutes?- NO

Answer 6

Thrombolysis

Question 7

When is thrombolysis (as Rx for ACS) used? (indications)

Answer 7

if PCI unavailable within 2 hours

• STEMI in two contiguous ECG leads
• new LBB

Question 8

If thrombolysis is not successful?

Answer 8

Resus PCI

Question 9

If presents with STEMI > 12 hours

Answer 9

Fondaparinux