Lesson 1Immediate pharmacologic measures for suspected MI: aspirin dosing, P2Y12 inhibitors selection and timing (clopidogrel, prasugrel, ticagrelor)Outlines first drug steps for suspected MI, stressing quick aspirin give, P2Y12 inhibitor pick and timing, loading doses, mix with blood thinners and reperfusion, allergy/prior therapy 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 oxygen and non-invasive breathing support needs in ACS, stressing no routine oxygen in normal oxygen levels, start thresholds, device pick, mix with blood flow and pain control.
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 reperfusion choices in STEMI and some NSTEMI, listing primary PCI criteria, fibrinolysis fit, time limits, no-go factors, conservative choice by lack of blood flow and bleed risk.
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-based doses of tenecteplase/alteplase, extra blood thinners, full/partial no-go, 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 attack, focus on custom reperfusion, blood flow support, careful pressor/vasoactive drug 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 routesExamines nitrates and morphine in ACS, needs for pain relief, no-go like low BP or right heart attack, give methods, doses, effects on preload, afterload, heart blood 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 issues, drug dose tweaks for thinners/contrast, kidney injury prevention from contrast, fluid handling, balance lack of blood flow/bleed risk 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 ACS blood thinners like UFH, enoxaparin, bivalirudin, doses in STEMI/NSTEMI, watch methods, kidney tweaks, handling during PCI/CABG.
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 anti-clot platelets in NSTEMI, aspirin/P2Y12 loading timing vs angio, agent choice, how lack of blood flow/bleed risk, other issues, procedures sway conservative 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 primary PCI flows, door-balloon goals, start/transfer plans, pre-PCI antiplatelet/thinner regimens, tailor thinners to bleed risk/lesion tough spots.
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-stabilise, no-go like shock/brady, start doses, ramp up, watch for low BP, 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 high-strength statins start in ED for ACS, proof for early use, right drugs/doses, liver baseline check, enzyme watch, statin side effect handling.
Evidence for early statin in ACS outcomesChoosing atorvastatin vs rosuvastatinInitial high-intensity dosing regimensBaseline liver tests and contraindicationsMonitoring and managing hepatic adverse events
