Acute Coronary Syndrome - Cardiac (non-arrest)

Question 1

In the ACS flowchart what is the order of administration for the recommended medications?

Answer 1

1. ASA (anaphylaxis is only contraindication - patch for early Clopidogrel if ASA contraindicated)
2. Nitro SL OR Nitro IV/IO (initiate then patch for IV/IO, no patch if maintaining IV/IO)
3. Fentanyl (preferred) OR Morphine if Nitro ineffective
4. Patch: Heparin IV/IO initiation (no patch if maintaining)
5. Patch: Metoprolol (if pt hypertensive or tachycardic)
6. Patch: Clopidogrel (preferred in NSTEMI) OR Ticagrelor

Question 2

If pt has suspected ACS with a MAP <70 what algorhythm/MDSO should you choose?

Answer 2

Treat with ACS MDSO and cardiogenic shock MDSO concurrently

Question 3

What are the 5 conditions for Nitroglycerin administration as per the ACS MDSO?

Answer 3

1. Pt >40 kg
2. MAP >70mmHg
3. HR is >60 beats and <160 beats per min
4. Pt is alert
5. Pt >18 yo (<18 yo requires patch)

Question 4

What are the 3 contraindications for Nitro administration in the ACS MDSO?

Answer 4

1. Allergy/sensitivity to nitrates
2. Phosphodiesterase-5 inhibitors* in the last 48 hrs
3. 12-lead ECG compatable with Right Ventricular MI

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