Acute Coronary Syndrome

Question 1

If STEMI & SBP>140, & HR>100

Answer 1

• Metoprolol 5 mg IV q 15 min x 3 doses as long as SBP >90 & HR>60
• May give in conjunction with NTG infusion for chest pain

Question 2

STEMI Criteria

Answer 2

ST segment elevation in two or more contiguous leads;
- >1 mm elevation in leads I, II, III, AVF, AVL, V1, V4, V5, V6
- >2mm elevation in leads V2, V3

Question 3

Heparin Administration (IFT w/ confirmed STEMI)

Answer 3

Bolus: 60 u/kg to max 5000 units
Infusion: 12 u/kg/hr, rounded to nearest 50 units, Max 1000 u/hr
*Mix 5000 u in 250 mL NS (20 u/mL)

Question 4

Heparin Contraindications

Answer 4

• Pt received low molecular weight Heparin
• INR over 2.5
• Evidence of bleeding

Question 5

Symptomatic sinus bradycardia w/ inferior wall MI - Epi

Answer 5

Infusion: 0-0.5 mcg/kg/min (IBW)

Question 6

Pain control (ACS)

Answer 6

• Fentanyl 1-2 mcg/kg IVP (to maximum single dose 100 mcg), q 5 min
• Morphine 2-5 mg increments q 5 min IVP

Question 7

NTG

Answer 7

• If SBP ≥ 100 mmHg give NTG 0.4 mg SL q 5 min x 3 as needed
  OR
• Initiate Nitroglycerin infusion (5-200 mcg/min) titrated to chest pain relief while maintaining SBP ≥100 50 mg in 250 ml D5W (200mcg/mL)