ACUTE CORONARY SYNDROME-MANAGEMENT (A. PRE HOSPITAL)

SUMMARY

2013 ACC/AHA Guidelines for chest pain:
1. Give non-enteric coated Aspirin (162-325 mg) as bite and chew x1.

2. Nitroglycerin (tablets or spray): give only 1 dose. If unimproved or worsening: give no more. If improved: can repeat to max of 3 doses (at 3-5-minute intervals).

3. If the patient has taken a phosphodiesterase-S inhibitor (e.g. sildenafil or vardenafil) within 24 hrs (48 hrs for tadalafil), do not give nitroglycerin due to the risk of severe hypotension!

4. Be prepared to manage ventricular arrhythmias.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].