Acute Coronary Syndrome

Question 1

ACS - Treatment Priorities

Answer 1

+ Aspirin 300mg orally pnc, once only

+ GTN 600mcg S/L/B (300mcg nil prev) pnc, repeated @5/60 ur/ose, no max

+ GTN transdermal patch 400mcg/hour

+ IV access

+ Morphine up to 5mg IV pnc, repeated @5/60 ur/ose (max 20mg) OR Fentanyl up to 50mcg IV pnc, repeated @5/60 ur/ose (max 200mcg)

+ Ondansetron 4mg ODT orally pnc, repeated @5-10/60 once only (max 8mg) OR Prochlorperazine 12.5mg IM pnc, once only

+ transport and r/v with MICA if required

Question 2

ACS - Pathophysiology

Answer 2

• Over time, the blood vessels become gradually hardened and narrowed, accumulating a build up of material called ‘plaque’ on their inner walls - mostly lipids and collagen - which protrudes into the vessel lumen. This build-up is especially prevalent in areas of higher turbulence (bends) and sites of injury
• In ACS, this plaque ruptures into the vessel and is carried in the bloodstream to another site where it attaches to the plaque, thereby reducing the lumen size at that point
• The rupture also initiates the clotting cascade and platelets and fibrin are recruited to form a thrombus at the site of the injury
• Where a thrombus or plaque build-up inhibit approx 70% of the blood flow distal to the occlusion, symptoms of ischaemia/infarct result.

Question 3

ACS - Signs and Symptoms

Answer 3

^ symptoms may occur at rest or during activity when blood flow is increased
^ central chest pain/discomfort radiating into neck and/or L) arm
^ nausea
^ diaphoresis, grey pallor

Other atypical symptoms include:
^ feeling generally unwell
^ pain in wrists, R) arm, back, shoulder tips