Algorithms
Adult ACLS
Acute Coronary Syndromes
12-lead within 10 minutes, aspirin, then reperfusion: primary PCI within 90 minutes or fibrinolysis within 30 minutes for STEMI.
Interactive pathway
- Assess
Symptoms suggestive of ischemia or infarction
- Chest pressure, radiation to arm/jaw, dyspnea, diaphoresis, nausea
- Women, older adults, and diabetics often present atypically
- Action
EMS assessment & care
- Monitor, ABCs; be ready for CPR and defibrillation
- Oxygen only if SpO₂ < 90%
- 12-lead ECG within 10 min; transmit and pre-notify the receiving hospital
- Fibrinolytic checklist if considering prehospital lysis
- Action
ED assessment (< 10 min)
- IV access, vital signs, SpO₂
- Brief targeted history and exam
- High-sensitivity troponin, electrolytes, coags
- Portable chest X-ray (< 30 min)
- Decision
STEMI or STEMI-equivalent?
ST elevation in ≥ 2 contiguous leads, posterior MI, de Winter T waves, or Sgarbossa-positive LBBB / paced rhythm