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Immediate management of suspected acute coronary syndrome

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Immediate management of a suspected acute coronary syndrome

  • management of ACS should start as soon as it is suspected, but should not delay transfer to hospital
  • offer pain relief as soon as possible. This may be achieved with GTN (sublingual or buccal), but offer intravenous opioids such as morphine, particularly if an acute myocardial infarction (MI) is suspected
    • offer people a single loading dose of 300 mg aspirin as soon as possible unless there is clear evidence that they are allergic to it
      • if aspirin is given before arrival at hospital, send a written record that it has been given with the person
      • only offer other antiplatelet agents in hospital. Follow appropriate management of unstable angina/NSTEMI or or local protocols for STEMI)
  • do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission. Only offer supplemental oxygen to:
    • people with oxygen saturation (SpO2) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO2 of 94-98%
    • people with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2 of 88-92% until blood gas analysis is available
  • monitor people with acute chest pain, using clinical judgement to decide how often this should be done, until a firm diagnosis is made. This should include:
    • exacerbations of pain and/or other symptoms
    • pulse and blood pressure
    • heart rhythm
    • oxygen saturation by pulse oximetry
    • repeated resting 12-lead ECGs and
    • checking pain relief is effective
  • manage other therapeutic interventions using appropriate guidance (management of unstable angina/NSTEMI or local protocols for STEMI).


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