ACS Slides 1 INTRO TO CODE BLUE ACS Anti-anginal O2, - - PowerPoint PPT Presentation

INTRO TO CODE BLUE ACS Slides

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INTRO TO CODE BLUE

ACS

① Anti-anginal § O2, nitroglycerin, morphine ① Anti-platelet § 1st: ASA (162mg PO chewable) § 2nd: P2Y12 inhibitor (clopidogrel, ticagrelor, or prasurgrel– not if hx stroke/TIA) § 3rd: glycoprotein IIb/IIIainhibitor (consider at PCI) ② Anti-coagulation § If fibrinolytics: UFH, LMWH, or fondaparinux § If PCI: UFH, bivalirudin, or UFH+bivalirudin ③ Revascularization § Fibrinolytics (TNK), PCI, or CABG ④ Risk factor reduction § Beta-blocker, ACEi/ARB, and Statin § Aldo antagonist (e.g. eplerenone): on BB/ACEi, either sx HF or DM, and EF<40% § Quit smoking

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INTRO TO CODE BLUE

ACS DOSES FOR SELECT MEDS

Drug Load Maintenance Duration ASA 160mg PO 81mg/day Lifelong Clopidogrel 600mg pre-PCI 300mg lytics <24h 75mg > age 75 75mg/day 1 year Ticagrelor* 180mg 90mg BID 1 year Heparin IV bolus weight based (load for STEMI only) IV infusion (Goal 1.5-2x PTT) 48h or until revascularization LMWH IV bolus weight based (load for STEMI only) SC injections Up to 8 days or until revascularization ACEi

• Lifelong

Beta-blocker

• 3 years

Statin

• Lifelong

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*Ticagreloras first line for 2nd antiplatelet, except if lysis for STEMI—use clopidogrel