Lesson 1Immediate pharmacologic measures for suspected MI: aspirin dosing, P2Y12 inhibitors selection and timing (clopidogrel, prasugrel, ticagrelor)Outlines first drug steps for likely MI, stressing quick aspirin, P2Y12 picks and times, load doses, with blood thinners and reopen plans, allergy/prior drug notes.
Aspirin loading dose and formulationsChoosing initial P2Y12 inhibitor in EDTiming of loading relative to PCI or lysisManaging prior DAPT or recent anticoagulantsDocumenting allergies and prior stent historyLesson 2Oxygen therapy and adjunctive measures: indications for supplemental oxygen and non-invasive ventilationReviews when for extra oxygen and mask breathing in ACS, avoiding routine in normal oxygen levels, start points, device picks, with blood flow and pain care.
Evidence against routine oxygen in normoxiaSpO2 thresholds to start supplemental oxygenChoosing nasal cannula vs mask vs HFNCIndications for CPAP or BiPAP in ACSMonitoring respiratory status and escalationLesson 3Reperfusion decision-making: criteria for primary PCI vs fibrinolysis vs conservative managementGuides reopen choices in STEMI and some NSTEMI, criteria for main PCI, when clot-busters fit, time limits, no-gos, and when watch-only based on blood lack and bleed risks.
STEMI criteria and symptom onset timingDoor-to-balloon and door-to-needle goalsAbsolute and relative lysis contraindicationsWhen to choose primary PCI over lysisConservative strategy in high-risk NSTEMILesson 4Fibrinolytic agents: indications, dosing (tenecteplase, alteplase), contraindications, and management of bleeding complicationsCovers clot-buster therapy for STEMI if PCI late, weight doses of tenecteplase/alteplase, extra blood thinners, no-gos, bleed spotting and handling.
STEMI patients eligible for fibrinolysisTenecteplase dosing by weight and ageAlteplase STEMI dosing protocolsAdjunct aspirin and anticoagulation useManaging intracranial and systemic bleedingLesson 5Special scenarios: cardiogenic shock, cardiac arrest with STEMI, right ventricular infarction — tailored reperfusion and pharmacologic adjustmentsHandles tough ACS cases like heart shock, arrest with STEMI, right heart infarct, with fit reopen plans, flow support, careful pressor tweaks.
Identifying and grading cardiogenic shockMechanical support options in shockPost–cardiac arrest STEMI pathwaysRight ventricular infarction recognitionAdjusting preload, afterload, and inotropesLesson 6Nitrates, morphine, and hemodynamic considerations: indications, contraindications, and administration routesLooks at nitrates and morphine in ACS for pain, no-gos like low pressure or right infarct, ways to give, doses, effects on heart fill, push, coronary flow.
Contraindications to nitrate therapySublingual vs IV nitrate administrationMorphine dosing and monitoringImpact on preload and afterloadInteractions with phosphodiesterase-5 inhibitorsLesson 7Renal dysfunction and drug selection: dose adjustments, contrast nephropathy prevention, and anticoagulation changes in CKDFocuses on ACS with kidney trouble, drug dose tweaks for thinners/contrast, kidney harm prevention from dye, fluids, balancing lack-blood and bleed risks in bad kidneys.
Estimating kidney function in the EDAdjusting anticoagulants in CKD and ESRDP2Y12 and statin choices in renal diseaseHydration and contrast minimization tacticsPost-contrast monitoring and nephrology consultsLesson 8Anticoagulation choices in ACS: UFH, bivalirudin, enoxaparin — dosing, monitoring, renal adjustments, and periprocedural considerationsCompares blood thinners in ACS: UFH, enoxaparin, bivalirudin, doses in STEMI/NSTEMI, checks, kidney tweaks, around PCI/CABG handling.
UFH bolus and infusion dosing in ACSEnoxaparin dosing and timing with PCIBivalirudin indications and dosingMonitoring ACT, aPTT, and anti-Xa levelsBridging and holding anticoagulants for CABGLesson 9Antiplatelet management in NSTEMI: timing of loading doses before coronary angiography and scenarios favoring conservative vs early invasive approachHandles platelet blockers in NSTEMI, aspirin/P2Y12 load times to angio, agent choice, how risks/comorbids/procedures sway watch vs early invasive.
Risk scores guiding invasive strategyTiming of P2Y12 loading before cathChoosing clopidogrel vs ticagrelor vs prasugrelManaging patients likely to need CABGDe-escalation and duration of DAPT in NSTEMILesson 10Primary PCI pathways: door-to-balloon targets, transfer protocols, pre-PCI medications, and antithrombotic strategyDetails main PCI flows, door-balloon goals, start/transfer plans, pre-PCI platelet/thinner regimens, thinner plans fit to bleed risk/lesion tough.
ED triage and cath lab activation stepsInterfacility transfer and transport timingPre-PCI aspirin and P2Y12 loadingChoice of UFH, bivalirudin, or enoxaparinPost-PCI antithrombotic continuation plansLesson 11Beta-blockers and ACE inhibitors/ARBs in acute setting: when to give, contraindications, initial dosing and monitoringReviews early beta-blockers/ACEi/ARBs in ACS post-stable, no-gos like shock/slow heart, start doses, ramps, checks for low pressure, kidney harm, high potassium.
Hemodynamic criteria before beta-blockersOral vs IV beta-blocker selectionStarting and titrating ACEI or ARBContraindications and caution flagsMonitoring blood pressure, creatinine, potassiumLesson 12High-intensity statin initiation in ED: rationale, dosing, and hepatic safety checksExplains starting strong statins in ED for ACS, proof for early, agents/doses, liver baseline, enzyme checks, handling statin issues.
Evidence for early statin in ACS outcomesChoosing atorvastatin vs rosuvastatinInitial high-intensity dosing regimensBaseline liver tests and contraindicationsMonitoring and managing hepatic adverse events
