Latest Updates in ACLS Acute Coronary Syndromes Algorithm 1
Symptoms of acute coronary syndrome 1
Immediate actions to take and medications 2
Symptoms of acute coronary syndromes vary depending on age, gender, or existing medical conditions. The symptoms of acute coronary syndrome include:
Dyspnea or shortness of breath.
Racing heartbeat.
Indigestion.
Sudden heavy sweating.
Vomiting or nausea.
Fainting.
Unusual fatigue.
Dizziness or feeling light-headed.
Chest discomfort or chest pain.
The ACLS acute coronary syndromes algorithm offers a systematic approach to managing patients with symptoms of infarction or ischemia. This includes rapid diagnosis, stratification of risks, and therapeutic intervention to improve patient outcomes. Here is how to manage a patient using the
algorithm:
To manage the patient, you must conduct an initial assessment as guided by the ACLS acute coronary syndromes algorithm. The initial assessment includes:
Primary survey:
You must begin the assessment by carrying out the ABCs to assess the patient’s condition. These include:
Airway: Begin by ensuring the patient’s airway is open and protected.
Breathing: The second step is to assess breathing. If the oxygen saturation level is below 90% or if the patient shows signs of respiratory distress, provide oxygen.
Circulation: Examine the patient’s blood pressure and pulse. At this point, you can initiate IV access to administer medication.
Disability: Assess the patient’s neurological status. To do it correctly, consider the AVPU formula (alert, voice, pain, unresponsive).
Exposure: Lastly, expose the patient’s chest to look out for signs of bleeding and trauma, among other conditions.
After the initial assessment, consider the following steps to manage the patient with guidance from the ACLS acute coronary syndromes algorithm:
12-Lead ECG: You must perform a 12-Lead ECG as soon as possible to determine the likelihood of STEMI (ST-Elevation Myocardial Infarction) or non-STEMI.
Aspirin: Administer aspirin to the patient at a dose of 160-325 mg orally unless contraindicated.
Nitroglycerin: Give sublingual nitroglycerin unless contraindicated by bradycardia, hypotension, or suspected right ventricular infarction.
Pain management: If chest pains persist despite using nitroglycerin, use morphine to manage the pain.
Manage the ST-elevation myocardial infarction (STEMI) to reduce the patient’s risk of complications or death. To manage STEMI, the ACLS acute coronary syndromes algorithm suggests :
The reperfusion therapy will treat the patient by restoring blood flow either around or through blocked arteries after a heart attack. The treatment options include:
Percutaneous Coronary Intervention (PCI): The PCI is one of the most preferred methods. You must aim at performing PCI within the initial 90 minutes after getting in contact with the patient.
Fibrinolytic therapy: If PCI is unavailable within the first two hours, initiate fibrinolytic therapy within 30 minutes of its arrival at the hospital.
Adjunctive therapy:
To improve the patient’s chances of survival, you can consider adjunctive therapy to manage STEMI. Consider options such as:
Antiplatelet agents: Give the patient some P2Y12 inhibitors such as ticagrelor, prasugrel, and clopidogrel, along with aspirin.
Anticoagulants: For anticoagulants, you can give the patient agents like bivalirudin, enoxaparin, or heparin.
Patients with non-STEMI are considered high-risk patients. As such, you need to give them aggressive care to enhance their survival and prevent death. To manage non-STEMI, consider:
High-risk patients: These are patients with continuous chest pain, heart failure, or hemodynamic instability. Ensure you give them an urgent evaluation and manage their symptoms effectively. Use early invasive strategies to manage the patient.
Moderate to low-risk patients: Ensure you monitor the patient with cardiac biomarkers and a series of ECGs. The results from these tests will guide you on further treatment.
Antiplatelet therapy: Give the patient some aspirin and increase the P2Y12 inhibitors.
Anticoagulation: Give the patient some anticoagulants such as heparin, fondaparinux, and enoxaparin.
Post-cardiac arrest care plays a significant role in improving the survival rate and reducing the mortality rate. To optimize the patient’s cardiopulmonary function and vital organ perfusion, consider the following steps as guided by the ACLS acute coronary syndromes algorithm:
TTM is useful for improving the patient’s neurological function and enhancing their survival. To manage the temperature, consider the following steps:
Maintain a temperature of 32°C and 37.5°C for a minimum of 24 hours after return of spontaneous circulation (ROSC) to reduce neurological damage.
Avoid exposing the patient to rapid rewarming to prevent fever in patients who are unresponsive after ROSC.
If a patient has ST-elevation on ECT post-cardiac arrest, carry out an emergent coronary angiography.
If a patient does not have an ST elevation but is at a high risk of coronary artery disease, consider giving them a coronary angiography.
If a patient fails to regain consciousness, use an electroencephalogram (EEG) to monitor them for seizure activities. Continued EEG monitoring is also useful as it can inform you of the need for rapid treatment.
In case the patient is not responding to the resuscitation efforts, consider doing extracorporeal cardiopulmonary resuscitation (ECPR).
Acute coronary syndromes are associated with a high rate of morbidity and mortality. You must recognize the symptoms of acute coronary syndromes to provide timely intervention. To assist you with this, the ACLS acute coronary syndromes algorithm provides a step-by-step guide from the initial assessment to the advanced interventions.
