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 fast aspirin, picking and timing P2Y12 blockers, loading doses, linking with blood thinners and reopening, and noting allergies or past treatment.
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 to use extra oxygen and non-invasive breathing help in ACS, stressing skip routine oxygen if oxygen levels normal, start points, device picks, and linking 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 reopening choices in STEMI and some NSTEMI, listing rules for main PCI, when clot-busters fit, time limits, no-go's, and when hold-back care best based on block 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 treatment for STEMI if PCI late, weight doses for tenecteplase/alteplase, extra blood thinners, full/partial no-go's, and spotting/handling bleeds.
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, heart stop with STEMI, right heart damage, focusing custom reopening, blood flow support, and careful tweaks to pressors and active 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 routesLooks at nitrates and morphine in ACS, when for pain relief, no-go's like low pressure or right heart damage, ways to give, doses, and effects on blood volume, resistance, 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, dose tweaks for blood thinners/contrast, plans to stop contrast kidney harm, fluid handling, balancing block and bleed 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 considerationsCompares blood thinner options in ACS like UFH, enoxaparin, bivalirudin, stressing doses in STEMI/NSTEMI, watch plans, kidney tweaks, and handling around 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 clot-blocker care in NSTEMI, timing aspirin/P2Y12 loads before angio, agent choice, how block/bleed risk, other ills, planned work sway hold-back vs early invasive ways.
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-to-balloon goals, start/transfer plans, pre-PCI clot-blocker/thinner sets, custom blood thinner plans to bleed risk and block toughness.
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 and ACEi/ARBs in ACS, timing post-stable, no-go's like shock/slow heart, start doses, ramp-up, watch 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 use, right drugs/doses, base liver checks, enzyme watch, handling statin issues or harm.
Evidence for early statin in ACS outcomesChoosing atorvastatin vs rosuvastatinInitial high-intensity dosing regimensBaseline liver tests and contraindicationsMonitoring and managing hepatic adverse events
