Treatment
ÎÎPrehospital EMS providers should administer 162-325 mg aspirin
(ASA) (chewed) to chest pain patients suspected of having ACS unless
contraindicated or already taken by the patient. Although some trials
have used enteric-coated ASA for initial dosing, more rapid buccal
absorption occurs with non–enteric-coated formulations. (I-C)
ÎÎHealth care providers should instruct patients with suspected ACS for
whom NTG has been prescribed previously to take not more than one
dose of NTG sublingually in response to chest discomfort/pain. (I-C)
ÎÎIf chest discomfort/pain is unimproved or is worsening 5 min after one
NTG dose has been taken, it is recommended that the patient or family
member/friend/caregiver call 9-1-1 immediately to access EMS before
taking additional NTG. (I-C)
ÎÎIn patients with chronic stable angina, if symptoms are significantly
improved by one dose of NTG, it is appropriate to instruct the patient
or family member/friend/caregiver to repeat NTG every 5 min for a
maximum of 3 doses and call 9-1-1 if symptoms have not resolved
completely. (I-C)
ÎÎPatients with a suspected ACS with chest discomfort or other ischemic
symptoms at rest for >20 min, hemodynamic instability, or recent
syncope or presyncope should be referred immediately to an ED. (I-C)
ÎÎOther patients with suspected ACS who are experiencing less severe
symptoms and who have none of the above high-risk features,
including those who respond to an NTG dose, may be seen initially in
an ED or an outpatient facility able to provide an acute evaluation. (I-C)
ÎÎIt is reasonable for health care providers and 9-1-1 dispatchers to
advise patients without a history of ASA allergy who have symptoms
of ACS to chew ASA (162-325 mg) while awaiting arrival of prehospital
EMS providers. Although some trials have used enteric-coated ASA for
initial dosing, more rapid buccal absorption occurs with non–entericcoated formulations. (IIa-B)
ÎÎIt is reasonable for health care providers and 9-1-1 dispatchers to
advise patients who tolerate NTG to repeat NTG every 5 min for a
maximum of 3 doses while awaiting ambulance arrival. (IIa-C)
ÎÎIt is reasonable that all prehospital EMS providers perform and
evaluate 12-lead ECGs in the field (if available) on chest pain patients
suspected of ACS to assist in triage decisions. ECGs with validated
computer-generated interpretation algorithms are recommended for
this purpose. (IIa-B)
ÎÎIf the 12-lead ECG shows evidence of acute injury or ischemia, it is
reasonable that prehospital advanced cardiac life support (ACLS)
providers relay the ECG to a predetermined medical control facility
and/or receiving hospital. (IIa-B)
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