Due to the large amount of important information contained in our ACLS algorithms, a printable PDF download link is available below.
Goals of therapy for ACS include:
Identification of patients with ST Elevation MI (STEMI) in order to facilitate early reperfusion
Relief of chest pain
Treatment of life-threatening complications including VF, VT and unstable tachyarrhythmias.
Prevention of major adverse cardiac events (MACE)
Recognition of symptoms of myocardial infarction (MI)
Chest pain or pressure
Radiation of pain to the jaw, shoulder, or arms
Lightheadedness, sweating, nausea or vomiting
Sudden shortness of breath
Activation of EMS system
Provide CPR (if necessary) while supporting the ABCs.
Administer aspirin if the patient is not allergic and does not have a recent history of GI bleeding.
Give the patient a nitroglycerin tablet every 3 to 5 minutes for ongoing pain AND if permitted by protocol.
Administer oxygen for an oxygen saturation <94% or if the patient appears to be short of breath.
Obtain and transmit a 12 lead ECG if possible; notify the hospital if there is any ST elevation.
If pain is not controlled by nitroglycerin, give morphine (by protocol or order).
Emergency Department (ED) Assessment and treatment
Perform a 12 lead ECG if one has not been done.
Establish an IV if not done by EMS
Give aspirin, nitroglycerin and morphine according to protocol or order; monitor for hypotension.
Continually monitor vital signs and oxygen saturation; if oxygen saturation is <94%, start oxygen at 2-4 L/minute and titrate.
Perform a brief assessment.
Complete the fibrinolytic checklist
Send baseline lab work.
Obtain portable chest x-ray.
Interpret the ECG.
Classify the ECG in one of three categories and provide treatment based on the category:
ST elevation MI (STEMI)
If the time from the onset of symptoms is more than 12 hours, follow the NSTEMI sequence
Additional therapies including heparin, beta blockers and ACE inhibitors may be started if these therapies do not delay reperfusion treatment.
Non ST elevation MI (NSTEMI)
Adjunctive therapies including heparin, beta blockers and ACE inhibitors may be started.
Admit to a monitored bed.
Consider statin therapy.
Normal or non-diagnostic ECG – Patient with a normal ECG are at low risk for ACS
If there are no abnormal tests during the hospitalization, discharge the patient with instructions for follow up.