Acute Coronary Syndrome

A-B-C Inital Assessment

Vital Signs - 12 Lead ECG

ST segment elevation > 1 mm in 2 or more contiguous leads

Inferior: (II, III, aVL)

Anterior: (V1 -V4)

Lateral: V5,V6, I, aVL

New or presumed new Left Bundle Branch Block (LBBB)

Yes
Code STEMI > Transmit ECG

  • Oxygen to maintain O2 saturation 92-99%
  • Intravenous access: isotonic crystalloid solution
  • Aspirin 324 mg chewed and swallowed
  • Nitroglycerine sublingual or transcutaneous
  • Morphine and/or Fentanyl for pain control
  • Repeat ECG for increase in pain or every 15 minutes

No
Non-STEMI / Unstable Angina

  • Oxygen to maintain O2 saturation 92-99%
  • Intravenous access with isotonic crystalloid
  • Aspirin 324 mg chewed and swallowed
  • Nitroglycerine sublingual or transcutaneous
  • Morphine or Fentanyl for pain control
  • Repeat ECG for increase in pain or every 15 minutes

Best Practices

  • Remove patient clothes; place in gown prior to transport/transfer
  • Provide receiving center pre-arrival update of current status with estimated arrival time
  • Transmit ECG’s if possible; articulate specific changes identified and patient condition, including history
  • EMS scene time: Initial response < 15 minutes

Informational purposes: This is not intended to replace your local or state clinical protocols or regulations.

Lead I
lateral (circumflex)		 Lead II
inferior (RCA)		 Lead III
inferior (RCA)
aVR V1
septal (LAD)		 V4
anterior (LAD)
aVL
lateral (circumflex)		 V2
septal (LAD)		 V5lateral(circumflex)
aVF
inferior (RCA)		 V3
anterior (LAD)		 V6
lateral (circumflex)

Normal intervals

PR Interval

0.12-.20sec or, 120-200ms

QRS Interval

0.06-1.12sec or, 60-120ms