Adult Medical Emergency Handbook - Scottish Intensive Care Society

i
Yes
SUMMARY OF MANAGEMENT OF
ACUTE CORONARY SYNDROME
Oxygen + cardiac rhythm monitoring
Intravenous access
Morphine 2.5 -10 mg iv + metoclopromide 10 mg iv
Aspirin 300 mg po +
Clopidogrel 300 mg po in unstable angina, clopidogrel 600 mg if for PCI
Metoprolol 5-15 mg iv 1
�
�
� Blood sampling: FBC, U&E, lipid profile, glucose,troponin
Transfer to a Specialist Cardiology Unit
Yes
Reperfusion Therapy
GP IIb/IIIa receptor
antagonist ivi +
Emergency PCI
Rapid
Primary
PCI
Available? 2
TIMI risk score
(Death, MI, recurrent ischaemia)
Low risk ≤ 2
Medium risk 3-4
High risk ≥ 5
GRACE score (Death)
Low risk ≤ 4.9%
Medium risk 5-9.9%
High risk ≥ 10%
Immediate Clinical Assessment
Electrocardiogram
No
ST Segment
Elevation ACS
Presenting