ACLS | Acute Coronary Syndrome

🔥 ACLS Deep Dive: High-Yield Crash Summary 🔥

1️⃣ Chain of Survival – Keep It Simple Recognize 🚨 → Activate EMS 🚑 → Rapid transport + prearrival notice → ED/cath lab diagnosis → Reperfusion 💥. STEMI survival depends on speed. Every second = muscle saved.

2️⃣ Shockable vs Nonshockable – Know the Split 💥 VFib & pulseless VT = shock now. 🫀 Asystole & PEA = compress & give epi. Defib/cardioversion breaks lethal rhythms; compressions buy time.

3️⃣ Key Meds & Timing ⏱️ • Aspirin: 162–325 mg, chewed, ASAP — blocks thromboxane A₂ to stop clot growth. • Nitroglycerin: Sublingual/translingual; repeat ×3 if SBP ≥ 90 mm Hg and no RV infarct. • Morphine: Only if pain persists after NTG. 🚫 Avoid if hypotensive. • Oxygen: Give only if SpO₂ < 90% or patient is dyspneic/hypoxemic. • Immediate priorities (<10 min): ABCs, IV access, ECG, labs, call cath team.

4️⃣ Brady vs Tachy – Pulse Present ⚡ Unstable bradycardia → pace. Unstable tachycardia → cardioversion. Unstable = hypotension, altered LOC, shock, chest pain, or pulmonary edema.

5️⃣ Cardiac Arrest Core Logic 🧠 • VF/pVT: Shock → CPR 2 min → shock → epi 1 mg q3–5 min → amio 300 mg bolus (then 150 mg). • Asystole/PEA: CPR + epi; no shock until rhythm changes. Keep compressions ≥ 2 in deep, rate 100–120/min, minimize interruptions.

6️⃣ Nursing Priorities 🩺 🚨 Call Rapid Response if HR < 40 / > 140, RR < 6 / > 30, SBP < 90, seizure, ↓LOC, or oliguria. 💡 When to Shock vs Compress: Shock for VF/pVT; compress for asystole/PEA. 💨 Airway: Manage ABCs first — secure airway, ventilate, oxygenate. 📊 Post-ROSC: Target ETCO₂ 35–40 mm Hg, O₂ 94–99%, maintain SBP > 90 mm Hg.

7️⃣ Contraindications & Traps ⚠️ • NTG/Morphine: Never in hypotension or RV infarct. • NSAIDs (except ASA): 🚫 During STEMI — ↑ risk of death, reinfarction, rupture. • Aspirin: Must be chewed (not enteric-coated). • Delay of Therapy = Death:

1️⃣ Diagnosis delay

2️⃣ Decision delay

3️⃣ Door-to-balloon delay

4️⃣ Door-to-departure delay

8️⃣ Reperfusion Goals ⏰ • PCI (door-to-balloon): ≤ 90 min from first medical contact. • Fibrinolysis (door-to-needle): ≤ 30 min of ED arrival. Miss these → ↑ mortality.

9️⃣ Rapid 2-Min Recall 🧩

1️⃣ RRT: HR < 40/>140, RR < 6/>30, SBP < 90.

2️⃣ ACS < 10 min: ABCs, IV, ECG, ASA, NTG, O₂ < 90%.

3️⃣ ASA 162–325 mg chewed.

4️⃣ NTG/Morphine 🚫 if hypotension or RV infarct.

5️⃣ PCI ≤ 90 min, Fibrinolysis ≤ 30 min.

6️⃣ No NSAIDs (except ASA).

Bottom line 💀: Stay calm, think algorithmically, don’t delay shocks, and hit those reperfusion windows like your patient’s life depends on it — because it does.