ACS: STEMI and NSTEMI Flashcards
Which A-E does this affect?
Circulation
Airway
Is patient vocalising?
Breathing
Look: respiratory distress, tripoding, use of accessory muscles, tracheal trug
Listen: breath sounds across both lungs, pulmonary oedema (fine crackles and can have wheeze)
Feel: symmetrical chest expansion, percuss lung fields
Obs:
1. Oxygen saturations, if low -> 15L O2 via non-rebreather mask
- RR may be elevated due to pain
Consider ABG and CXR if respiratory cause of chest pain
Circulation
Look: Scars on chest? Fluid status – overload? Raised JVP, pitting oedema, sacral and pedal
Feel: CRT, Pulse (HR), BP both arms lying and standing
Listen: Auscultate heart sounds – any additional sounds?
IV access – 2 wide bore cannulae
Bloods – FBC, U&Es, LFTs, CRP, troponin, BNP, G&S, clotting, glucose, lipids, cholesterol
ECG:
STEMI:
1) ST elevation >1mm in >=2 adjacent limb leads or >2mm in >= adjacent chest leads
2) New LBBB
3) Posterior changes: deep S5:15 PM depression and tall R waves in V1-V3
STEMI Management
Give PO 300mg stat aspirin and 300mg stat clopidogrel or 180mg ticagrelor
IV Morphine 5-10mg
Anti-emetics e.g. IV 10mg metoclopramide
GTN spray
Call senior and cath lab for PCI within 120 mins
Reverse any anticoagulants
If PCI not available may consider fibrinolysis/thrombolysis with alteplase
NSTEMI Management
Give PO 300mg stat aspirin and 300mg stat clopidogrel or 180mg ticagrelor
Subcutaneous fondaparinux 2.5mg OD (factor 10 a inhibitor) can also use LMWH e.g enoxaparin 1mg/kg/12hr
IV Morphine 5-10mg
GTN spray
Call senior
PCI if high grace score and ongoing angina or evolving ECG changes, signs of shock or high risk patient
If low risk patient, PCI within 72 hours
Disability
BM, GCS, PEARL
Exposure
Temperature, rashes, abdominal examination, calves, urine output, catheter
Long term management: ACEi, BB, metformin, statin etc. and lifestyle measures
GRACE score: admission 6 month mortality after ACS
Findings on A-E
Overall management
Overall management 2
