Adult health (medicine) Knowledge organiser
Acute coronary syndrome: initial management
Chest pain with an ECG showing ST elevation is a STEMI until proven otherwise and needs reperfusion within minutes. Without ST elevation, serial troponins and a risk score decide between NSTEMI, unstable angina and a non-cardiac cause.
The rule
NHFA/CSANZ Australian Clinical Guidelines for the Management of Acute Coronary Syndromes (2016): all suspected ACS receives aspirin 300 mg unless contraindicated. STEMI: primary PCI if it can be delivered within 90 minutes of first medical contact (120 minutes if transfer is needed); otherwise fibrinolysis (tenecteplase) within 30 minutes of arrival, then transfer to a PCI centre. NSTEACS: risk stratify, dual antiplatelet therapy and anticoagulation, with angiography within 72 hours for high-risk patients.
Exam trap
A rural presentation more than 120 minutes from a catheter laboratory: the correct answer is fibrinolysis now, not a helicopter and no drug.
Show distinctions and misconceptionsHide
- STEMI is an ECG diagnosis made on the first ECG within 10 minutes of arrival; NSTEMI is a troponin diagnosis made over time.
- Fibrinolysis is a bridge to PCI in rural Australia, not an alternative to it: transfer to a PCI centre still follows.
- Oxygen is given only if SpO2 is below 94 percent (AVOID trial); routine oxygen in normoxic patients is not recommended.