Contact us about setting up a corporate account with complimentary printed posters
Using the Acute Coronary Syndromes Algorithm for Managing the Patient
The Acute Coronary Syndromes Algorithm outlines the steps for assessment and management of a patient with ACS. The algorithm begins with the assessment of chest pain and whether it is indicative of ischemia. The assessment and management begin with the EMS responder outside of the hospital who can give oxygen, aspirin, nitroglycerin, and morphine (if needed for pain). An initial 12-lead ECG can also be obtained. Treatment and assessment continues when the patient arrives at the hospital, following the time sequences suggested in the algorithm. Serial cardiac markers (CK-MB, cardiac troponins) provide additional information and allow refined stratification and treatment recommendations.
Decision 1: Does the patient have chest discomfort suggestive of ischemia?
An affirmative answer starts the algorithm.
Assess and care for the patient using the primary and secondary surveys.
Prepare patient for hospital admission.
Monitor and support ABCs (airway, breathing, and circulation).
Take vital signs.
Be prepared to administer CPR if the need arises. Watch for it.
Use a defibrillator if necessary.
Think MONA: Administer oxygen, aspirin, nitroglycerin, and morphine, if needed.
If possible, obtain a 12-lead ECG.
Interpret or request an interpretation of the ECG.
If ST elevation is present, transmit the results to the receiving hospital.
Hospital personnel gather resources to respond to STEMI.
Start filling out a fibrinolytic checklist.
Within the first 10 minutes that the patient is in the Emergency Department (ED), work through the following:
Check vital signs.
Evaluate oxygen saturation.
Establish IV access.
Get or review a 12-lead ECG.
Look for risk factors for ACS, cardiac history, signs and symptoms of heart failure by taking a brief, targeted history.
Perform a physical exam.
Complete a fibrinolytic checklist and check contraindication
Obtain a portable x-ray (less than 30 minutes).
Begin general treatment in the ED:
Start oxygen at 4 L/min and maintain oxygen saturation > 90%.
If the patient did not take aspirin while with the EMS provider, give aspirin (160 to 325 mg).
Administer nitroglycerin, either sublingual, spray, or IV.
Give the patient morphine (IV) if pain is not relieved by nitroglycerin.
Decision 2: Classify the patient according to presentation of ST-segment.
The 12-lead ECG is at the heart of the decision pathway in the management of ischemic chest pain and is the only means of identifying STEMI.
Note:The ECG classification of ischemic syndromes is not meant to be exclusive.