ACLS for Acute Coronary Syndrome (ACS)

Acute Coronary Syndrome (ACS) encompasses a range of conditions associated with sudden, reduced blood flow to the heart. This includes unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). ¹ Rapid recognition and appropriate management are crucial to minimize myocardial damage and improve patient outcomes. ACLS providers play a vital role in the initial assessment and stabilization of ACS patients.

RECOGNIZING ACS

Chest Pain/Discomfort: This is the most common symptom. It may be described as pressure, tightness, squeezing, or a burning sensation in the chest. It may radiate to the arms, shoulders, neck, jaw, or back. Other Symptoms: These may include shortness of breath, nausea, vomiting, diaphoresis (sweating), lightheadedness, or syncope (fainting).

INITIAL ASSESSMENT AND STABILIZATION

ACLS providers should focus on the following during the initial assessment and stabilization of a suspected ACS patient:

1. Airway, Breathing, and Circulation (ABCs): Ensure a patent airway, adequate breathing, and stable circulation. Provide supplemental oxygen if needed.
2. Obtain a 12-Lead ECG: This is crucial for identifying STEMI and guiding treatment decisions.
3. Establish IV Access: Establish IV access for administration of medications.
4. Administer Oxygen: Administer supplemental oxygen if the patient is hypoxic (SpO2 < 90%).
5. Administer Aspirin: Administer aspirin (162-325 mg) orally, if not contraindicated.
6. Administer Nitroglycerin: Administer nitroglycerin sublingually or as a spray, if the patient’s blood pressure is stable and not contraindicated.
7. Administer Morphine: Consider morphine for pain management if nitroglycerin is ineffective.
8. Monitor Vital Signs: Continuously monitor vital signs, including blood pressure, heart rate, and oxygen saturation.

KEY CONSIDERATIONS IN STEMI

• Rapid Reperfusion Therapy: This is the primary goal of STEMI management. It can be achieved through percutaneous coronary intervention (PCI) or fibrinolytic therapy.
• Time is Muscle: The sooner reperfusion therapy is initiated, the less myocardial damage occurs.

KEY CONSIDERATIONS IN NSTEMI/Unstable Angina

• Antiplatelet and Antithrombotic Therapy: These medications are used to prevent further clot formation.
• Risk Stratification: Patients are risk-stratified to determine the need for further invasive management.

TRANSPORT TO A CARDIAC CENTER

Rapid transport to a cardiac center capable of performing PCI is essential for patients with STEMI.

This lesson provided an overview of ACLS interventions for ACS. Rapid recognition and appropriate management are crucial for improving patient outcomes.