Definition
Acute coronary Syndromes shown to some conditions. The group consists of:
1. Unstable angina
2. Non ST segment elevation Myocardial Infarction (NSTEMI)
3. ST Segment Elevation Myocardial Infarction (STEMI)
Disease process occurs because:
1. Bleeding in the plaque. Plaque causes swelling and a decrease in arterial lumen cross-sectional area.
2. Contraction of smooth muscle in artery walls. This contraction causes contractions in the lumen of the artery.
3. Thrombus formation on the surface of the plaque. This can cause partial blockage of the artery lumen until complete.
The all cause a decrease of blood flow to the myokardium.
Stable angina
Signs and Symptoms
Signs and symptoms of ACS in principle the same. In general, patients menyeluh:
1. Chest pain described as: a. Cramped, b. Pain such as indigestion,
c. As a fall, d. As there is a chest bandage, e. There is a case of people sitting on the chest
2. Pain spreading to the left hand, both hands and / or to the chin.
3. Pain likely be followed by: a. Sweating, b. Shortness of breath, c. Nausea and vomiting
Stable angina pain occurs only during exercise and there are fast disappearing at rest.
Unstable angina
Unlike stable angina, unstable angina was defined as occurrence of one or more of the following events: 1. Angina that occurs at a certain time period ranging from several days and increased in the attack. The increase was due to fewer trigger factors or less. This condition is often referred to as crescendo angina. 2. Incidence of recurrent angina episode and often unpredictable. Unstable angina does not trigger because the sport is not so clear. Usually occurs within a short time and disappear spontaneously or may be lost temporarily by drinking virgin glyceryl trinitrate (GTN), a sub lingual. 3. No originators and chest pain that extends. No evidence of infarction myokardial
Signs and Symptoms
1. Chest pain described as: a. Cramped, b. Pain such as indigestion,
c. As a fall, d. As there is a chest bandage, e. There is a case of people sitting on the chest
2. Pain spreading to the left hand, both hands and / or to the chin.
3. Pain likely be followed by: a. Sweating, b. Shortness of breath, c. Nausea and vomiting
Assessment
The main complaint is felt and assessment of vital signs. Always using ABCDE assessment principles.
Airway
1. Assess and maintain airway
2. Do the head tilt, chin lift
3. Use a respirator if needed
4. Consider referring to a part of anesthesia for intubation performed if it can not properly maintain the airway.
Breathing
1. Assess oxygen saturation using pulse oximeter with the aim of maintaining oxygen saturation more than 92%.
2. Give oxygen with high alirang via bag-valve-mask Ventilation.
3. Review of Respiratory
4. Perform system checks penapasan
5. Perform chest x-ray examination
Circulation
1. Assess heart rate and rhythm.
2. Measuring blood pressure
3. Perform EKG - may be normal but usually there is ST depression
4. Put Access IV (intravenous)
5. Do blood tests, heart or troponin enjim depending on local protocol (enjim and troponin are usually not elevated in unstable angina.
6. Remember MONA
a. Morphine - given five mg IV
b. Oxygen - high flow
c. Nitrate - give sublingual
d. Aspirin - 300 mg given
7. Consider giving low molecular weight heparin until the patient was free of pain within 24 hours.
8. Consider to give Clopidogrel 300 mg followed by 75 mg per day given
Disability
1. Assess the level kesaddaran using AVPU.
Exposure
1. Perform health checks and a history of illness when the patient is stable.
NON-ST elevation myocardial infarction
In some patients with NSTEMI, they have a high risk for coronary artery congestion, which can cause myocardial damage is more extensive and arrhythmias that can cause death. The risk for occurrence of traffic jams can occur in the first few hours and disappear in line with the time
Signs and Symptoms
1. Chest pain described as: a. Cramped, b. Pain such as indigestion,
c. As a fall, d. As there is a chest bandage, e. There is a case of people sitting on the chest
2. Pain spreading to the left hand, both hands and / or to the chin.
3. Pain likely be followed by: a. Sweating, b. Shortness of breath, c. Nausea and vomiting
Assessment
Chief complaint and vital signs assessments. Medical assistance should be done immediately. Perform assessment using ABCDE principles:
Airway
1. Assess and maintain airway
2. Make a tilt head, chin lift if necessary
3. Use a tool in freeing the airway if necessary
4. Consider referring to a part of anesthesia for intubation performed if not able to maintain airway.
Breathing
1. Assess oxygen saturation using pulse oximeter in order to maintain oxygen saturation of more than 92%.
2. Give alirang oxygen with a high through-valve-mask bags Ventilation.
3. Assess the number of respiratory
4. Perform system checks penapasan
5. Perform chest x-ray examination
Circulation
1. Assess heart rate and rhythm.
2. Measuring blood pressure
3. Perform EKG - may be normal but usually there is ST depression
4. Put Access IV (intravenous)
5. Do blood tests, heart or troponin enjim depending on local protocol (number enjim and troponin myokardial usually indicates the level of damage).
6. Monitor blood sugar
7. Remember MONA: a. Morphine - give 5 mg IV, b. Oxygen - high flow, c. Nitrate - give sublingual, d. Aspirin - 300 mg given
8. Consider giving low molecular weight heparin to patients free of pain within 24 hours.
Nine. Consider to give Clopidogrel 300 mg followed by 75 mg per day given
10. Consider giving beta blockers and statins must be taken into account
Disability
1. Assess the level kesaddaran using AVPU.
Exposure
1. Perform health checks and a history of illness when the patient is stable. Patients with less NSTEMI is not allowed to drive a vehicle within 4 (four) weeks.
ST elevation myocardial infarction
STEMI occurred because a complete blockage in coronary arteries. If not done the treatment can cause further myocardial damage. In high-risk acute phase for patients experiencing ventricular fibrillation or takhikardi which can cause death. Medical assistance should be done immediately.
Signs and symptoms
1. Chest pain described as: a. Cramped, b. Pain such as indigestion,
c. As a fall, d. As there is a chest bandage, e. There is a case of people sitting on the chest
2. Pain spreading to the left hand, both hands and / or to the chin.
3. Pain likely be followed by: a. Sweating, b. Shortness of breath, c. Nausea and vomiting
Airway
1. Assess and maintain airway
2. Do the head tilt, chin lift if necessary
3. Use a tool in freeing the airway if necessary
4. Consider referring to a part of anesthesia for intubation performed if the airway can not be maintained.
Breathing
1. Assess oxygen saturation using pulse oximeter in order to maintain oxygen saturation of more than 92%.
2. Give oxygen with high alirang through bag-valve-mask Ventilation.
3. Assess the number of respiratory
4. Perform system checks penapasan
5. Perform chest x-ray examination
Circulation
1. Kaji heart rate and rhythm.
2. Measure blood pressure
3. Perform EKG - ST elevation acute or bundle branch block (LBBB) newly added by myokardial infarct signs is an indication for reperfusion therapy performed.
4. The characteristic ECG in STEMI
a. Anterior / anteroseptal - seen in V1-V4
b. Inferior - seen in II, III and aVF
c. Lateral - look at the V5-V6 and I and aVL
d. posterior - anterior reciprocal changes in leads
5. Put Access IV (intravenous)
6. Do blood tests, heart or troponin enjim depending on local protocol (number enjim and troponin usually indicates the level of damage myokardial).
7. Monitor blood sugar
8. Remember MONA
a. Morphine - give 5 mg IV
b. Oxygen - high flow
c. Nitrate - give sublingual
d. Aspirin - 300 mg given
Nine. Consider giving low molecular weight heparin until the patient was free of pain within 24 hours.
10. Consider to give Clopidogrel 300 mg followed by 75 mg per day given
11. Assess the possibility of giving thrombolysis - a drug commonly used are:
a. streptokinase - 1.5 million units in normal saline 100 MLS
b. alteplase - infuskan 15 mg bolus then 0.75 mg / kg during the first hour
c. reteplase - 10 units bolus then 10 units after 30 minutes
d. tenecteplase - 30-50 mg (6.000 to 10.000 units) bolus
12. All patients were referred immediately to memelukan cardiologist
Disability
1. Kaji kesaddaran level by using AVPU.
Exposure
Perform health checks and a history of illness when the patient is stable. Patients with less NSTEMI are not allowed to drive a vehicle within 4 (four) weeks.
