Adult Medical Emergency Handbook - Scottish Intensive Care Society

IMMEDIATE MANAGEMENT OF ACUTE CORONARY SYNDROME
This section refers to all categories of ACS including those patients
with ST segment elevation. In the event of unstable angina or acute
MI including STEMI occurring in the wards, theatres or other clinical
areas at WGH or SJH treatment should be initiated as described in this
chapter and the Cardiology Registrar should be contacted.
Typical history of ACS
Establish continuous ECG monitoring
• Oxygen to keep SpO >97%
2
• IV access (2 for those receiving TNK)
• Anti-emetic: metoclopramide 10mg IV standard
• Morphine 2.5-10mg IV initially
• Aspirin 300mg to chew (unless already given by ambulance crew)
and clopidogrel 300mg or 600mg if ECG shows ST elevation
• Blood sampling for U+Es, lipid profile, glucose, FBC
CONTACT CARDIOLOGY see page 94
IMMEDIATE MANAGEMENT OF ST ELEVATION
ACUTE CORONARY SYNDROME
All patients with ST segment elevation acute coronary syndrome
presenting within 12 hours of symptom onset should be considered
for immediate reperfusion therapy.
If the ECG is normal, immediate reperfusion therapy should not
be given, even if the history is suggestive of MI. ‘T’ wave inversion
and widespread ST depression is not an indication for immediate
reperfusion therapy. If there is diagnostic doubt then consider:
• Posterior ECG leads [ST elevation in 2 or more contiguous leads
V7-V9]
• Repeat ECG after 10 minutes
• Early Cardiology opinion
Primary Percutaneous Coronary Intervention (PCI)
When compared with thrombolysis, primary PCI reduces short and
100 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11