Aralin 1Immediate pharmacologic measures para sa suspected MI: aspirin dosing, P2Y12 inhibitors selection at timing (clopidogrel, prasugrel, ticagrelor)Ang seksyong ito ay nag-ooutline ng immediate pharmacologic steps para sa suspected MI, na nagbibigay-diin sa mabilis na aspirin administration, selection at timing ng P2Y12 inhibitors, loading doses, integration sa anticoagulation at reperfusion plans, at documentation ng allergies o prior therapy.
Aspirin loading dose at formulationsPagpili ng initial P2Y12 inhibitor sa EDTiming ng loading relative sa PCI o lysisPag-manage ng prior DAPT o recent anticoagulantsPag-document ng allergies at prior stent historyAralin 2Oxygen therapy at adjunctive measures: indications para sa supplemental oxygen at non-invasive ventilationAng seksyong ito ay nagre-review ng indications para sa supplemental oxygen at non-invasive ventilation sa ACS, na nagbibigay-diin sa pag-iwas sa routine oxygen sa normoxia, thresholds para sa initiation, device selection, at integration sa hemodynamic at analgesic management.
Evidence laban sa routine oxygen sa normoxiaSpO2 thresholds upang simulan ang supplemental oxygenPagpili ng nasal cannula vs mask vs HFNCIndications para sa CPAP o BiPAP sa ACSPagmo-monitor ng respiratory status at escalationAralin 3Reperfusion decision-making: criteria para sa primary PCI vs fibrinolysis vs conservative managementAng seksyong ito ay gumagabay sa reperfusion decisions sa STEMI at selected NSTEMI, na nag-ooutline ng criteria para sa primary PCI, kailan ang fibrinolysis ay angkop, timing thresholds, contraindications, at kailan conservative management ang mas gusto batay sa ischemic at bleeding risk.
STEMI criteria at symptom onset timingDoor-to-balloon at door-to-needle goalsAbsolute at relative lysis contraindicationsKailan pipiliin ang primary PCI kaysa lysisConservative strategy sa high-risk NSTEMIAralin 4Fibrinolytic agents: indications, dosing (tenecteplase, alteplase), contraindications, at management ng bleeding complicationsAng seksyong ito ay tumutugan ang fibrinolytic therapy para sa STEMI, kabilang ang indications kapag na-delay ang PCI, weight-based dosing ng tenecteplase at alteplase, adjunctive antithrombotics, absolute at relative contraindications, at recognition at management ng bleeding.
STEMI patients na eligible para sa fibrinolysisTenecteplase dosing batay sa weight at ageAlteplase STEMI dosing protocolsAdjunct aspirin at anticoagulation usePag-manage ng intracranial at systemic bleedingAralin 5Special scenarios: cardiogenic shock, cardiac arrest na may STEMI, right ventricular infarction — tailored reperfusion at pharmacologic adjustmentsAng seksyong ito ay tumutugon sa complex ACS scenarios, kabilang ang cardiogenic shock, cardiac arrest na may STEMI, at right ventricular infarction, na nakatuon sa tailored reperfusion strategies, hemodynamic support, at maingat na adjustment ng vasopressors at vasoactive drugs.
Pagkilala at grading ng cardiogenic shockMechanical support options sa shockPost-cardiac arrest STEMI pathwaysRight ventricular infarction recognitionPag-adjust ng preload, afterload, at inotropesAralin 6Nitrates, morphine, at hemodynamic considerations: indications, contraindications, at administration routesAng seksyong ito ay sinusuri ang nitrates at morphine sa ACS, kabilang ang indications para sa symptom relief, contraindications tulad ng hypotension o RV infarction, routes ng administration, dosing, at kanilang hemodynamic effects sa preload, afterload, at coronary perfusion.
Contraindications sa nitrate therapySublingual vs IV nitrate administrationMorphine dosing at monitoringImpact sa preload at afterloadInteractions sa phosphodiesterase-5 inhibitorsAralin 7Renal dysfunction at drug selection: dose adjustments, contrast nephropathy prevention, at anticoagulation changes sa CKDAng seksyong ito ay nakatuon sa ACS patients na may CKD, na nagdedetalye ng dose adjustments para sa antithrombotics at contrast agents, strategies upang iwasan ang contrast-associated kidney injury, fluid management, at pagbalanse ng ischemic at bleeding risks sa advanced renal disease.
Pag-estimate ng kidney function sa EDPag-adjust ng anticoagulants sa CKD at ESRDP2Y12 at statin choices sa renal diseaseHydration at contrast minimization tacticsPost-contrast monitoring at nephrology consultsAralin 8Anticoagulation choices sa ACS: UFH, bivalirudin, enoxaparin — dosing, monitoring, renal adjustments, at periprocedural considerationsAng seksyong ito ay nagkukumpara ng anticoagulant options sa ACS, kabilang ang UFH, enoxaparin, at bivalirudin, na may diin sa dosing sa STEMI at NSTEMI, monitoring strategies, renal dose adjustments, at periprocedural management sa panahon ng PCI o CABG.
UFH bolus at infusion dosing sa ACSEnoxaparin dosing at timing sa PCIBivalirudin indications at dosingPagmo-monitor ng ACT, aPTT, at anti-Xa levelsBridging at holding anticoagulants para sa CABGAralin 9Antiplatelet management sa NSTEMI: timing ng loading doses bago coronary angiography at scenarios na mas gusto conservative vs early invasive approachAng seksyong ito ay tumutugon sa antiplatelet therapy sa NSTEMI, na nakatuon sa timing ng aspirin at P2Y12 loading relative sa angiography, choice ng agent, at kung paano ischemic at bleeding risk, comorbidities, at planned procedures ang nakakaapekto sa conservative versus early invasive strategies.
Risk scores na gumagabay sa invasive strategyTiming ng P2Y12 loading bago cathPagpili ng clopidogrel vs ticagrelor vs prasugrelPag-manage ng patients na malamang kailangan ng CABGDe-escalation at duration ng DAPT sa NSTEMIAralin 10Primary PCI pathways: door-to-balloon targets, transfer protocols, pre-PCI medications, at antithrombotic strategyAng seksyong ito ay nagdedetalye ng primary PCI workflows, kabilang ang door-to-balloon targets, activation at transfer protocols, pre-PCI antiplatelet at anticoagulant regimens, at pag-tailor ng antithrombotic strategies sa bleeding risk at lesion complexity.
ED triage at cath lab activation stepsInterfacility transfer at transport timingPre-PCI aspirin at P2Y12 loadingPagpili ng UFH, bivalirudin, o enoxaparinPost-PCI antithrombotic continuation plansAralin 11Beta-blockers at ACE inhibitors/ARBs sa acute setting: kailan bigyan, contraindications, initial dosing at monitoringAng seksyong ito ay nagre-review ng maagang paggamit ng beta-blockers at ACE inhibitors o ARBs sa ACS, kabilang ang timing pagkatapos ng stabilization, contraindications tulad ng shock o bradycardia, initial dosing strategies, titration, at monitoring para sa hypotension, renal injury, at hyperkalemia.
Hemodynamic criteria bago beta-blockersOral vs IV beta-blocker selectionPag-start at pag-titrate ng ACEI o ARBContraindications at caution flagsPagmo-monitor ng blood pressure, creatinine, potassiumAralin 12High-intensity statin initiation sa ED: rationale, dosing, at hepatic safety checksAng seksyong ito ay nagpapaliwanag kung bakit high-intensity statins ay sinisimulan sa ED para sa ACS, na sumasaklaw sa evidence para sa maagang paggamit, angkop na agents at doses, baseline hepatic assessment, monitoring ng liver enzymes, at pag-manage ng suspected statin intolerance o injury.
Evidence para sa early statin sa ACS outcomesPagpili ng atorvastatin vs rosuvastatinInitial high-intensity dosing regimensBaseline liver tests at contraindicationsMonitoring at pag-manage ng hepatic adverse events
