Lesson 1Immediate pharmacologic measures for suspected MI: aspirin dosing, P2Y12 inhibitors selection and timing (clopidogrel, prasugrel, ticagrelor)Dis part lay out immediate drug steps fi suspected MI, stressin quick aspirin give, pick an timin of P2Y12 inhibitors, loadin doses, mixin wid blood thinner an reperfusion plans, an notin allergies or past therapy.
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 ventilationDis part review when fi use extra oxygen an non-invasive breathin help in ACS, stressin nuh routine oxygen in normal oxygen levels, start thresholds, device pick, an mixin wid blood flow an pain management.
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 managementDis part guide reperfusion choices in STEMI an pick NSTEMI, layin out criteria fi primary PCI, when fibrinolysis fit, timin limits, no-goes, an when conservative better base pon lack blood an bleedin 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 complicationsDis part cover fibrinolytic therapy fi STEMI, includin when PCI late, weight-base dosin of tenecteplase an alteplase, extra blood thinners, absolute an relative no-goes, an spot an handle bleedin.
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 adjustmentsDis part tackle complex ACS cases, like heart shock, heart stop wid STEMI, an right heart infarct, focusin tailor reperfusion plans, blood flow support, an careful tweak of pressors an vasoactive drugs.
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 routesDis part check nitrates an morphine in ACS, includin when fi ease symptoms, no-goes like low pressure or right heart infarct, give ways, dosin, an dem effects pon preload, afterload, an 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 CKDDis part zero in pon ACS patients wid kidney trouble, detailin dose tweaks fi blood thinners an contrast, plans fi stop contrast kidney damage, fluid handle, an balancin lack blood an bleedin risks in bad kidney disease.
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 considerationsDis part compare blood thinner options in ACS, like UFH, enoxaparin, an bivalirudin, stressin dosin in STEMI an NSTEMI, watch plans, kidney dose tweaks, an handle durin PCI or bypass.
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 approachDis part deal wid antiplatelet therapy in NSTEMI, focusin timin of aspirin an P2Y12 loadin fi angiography, agent pick, an how lack blood an bleedin risk, extra conditions, an plan 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 strategyDis part detail primary PCI flows, includin door-to-balloon goals, activate an transfer plans, pre-PCI antiplatelet an blood thinner sets, an tailor blood thinner plans to bleedin risk an blockage hardness.
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 monitoringDis part review early use of beta-blockers an ACE inhibitors or ARBs in ACS, includin timin after steady, no-goes like shock or slow heart, start dosin plans, step up, an watch fi low pressure, kidney hurt, an 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 checksDis part splain why high-power statins start in ED fi ACS, coverin proof fi early use, right agents an doses, base liver check, watch liver enzymes, an handle statin no-like or hurt.
Evidence for early statin in ACS outcomesChoosing atorvastatin vs rosuvastatinInitial high-intensity dosing regimensBaseline liver tests and contraindicationsMonitoring and managing hepatic adverse events
