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6 Cards in this Set
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Anti-Ischemic Tx:
Nitrate BB CCB (for asthmatics) Morphine O2 |
NTG 0.4mg SL q 5min x 3
Metoprolol 5mg IV q 5min x 3, then 25PO q 6hrs, titrate to HR55-60. Verapamil 5mg IV Morphine Sulfate 2-5mg IV q5-30min O2 for sats <90% |
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Anti-Platelet:
ASA Clopidegrel GPIIbIIIa Inhibitor |
ASA 325mg PO, then 162mg PO daily
Clopidogrel 300mg PO, then 75mg PO daily (takes 6hrs to reach steady state, some people use 600mg initial dose) Abciximab 0.25mg/kg IVB then 0.125mcg/kg/min OR Integrilin (Eptifibatide) 180mcg/kg IVB, then 2mcg/kg/min (1 if CrCl<50) |
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Anti-Coagulation Tx:
LMWH UFH Direct Thrombin Inhibitor (pts with HIT) at PCI? Xa Inhibitor |
Enoxaparin 1mg/kg SC bid
UFH 60U/kg IVB (max 4000U) then 12U/kg/h (max 1000U/hr) Angiomax (Bivalivudin) 0.1mg/kg IVB, then 0.25mg/kg/hr. At PCI: 0.50mg/kg IVB, then 1.75mg/kg/hr Arixtra (Fondaparinux) 2.5mg SC daily. Must supplement with UFH if PCI |
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TIMI Score
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Age (greater than 65 years)
Markers (raised serum cardiac markers) ECG (ST-segment depression at presentation) Risk factors (at least three for coronary artery disease) Ischemia (at least two anginal events in previous 24 hours) Coronary stenosis (prior stenosis of 50% or more) Aspirin (use in previous 7 days) |
AMERICA |
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Indications for PCI
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Skilled technician available w/o delay
High risk STEMI Contra to lysis Late presentation (>3h) Dx STEMI in doubt |
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Indication for fibrinolysis
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<3hrs
Delay to PCI (>90min) invasive not an option |
