<HTML><HEAD> <META NAME="GENERATOR" CONTENT="Adobe PageMill 2.0 Win"> <TITLE>Untitled Document</TITLE></HEAD><BODY TEXT="#bafddc" BGCOLOR="#006666"><TABLE WIDTH="483" BORDER="1" CELLSPACING="2" CELLPADDING="5" HEIGHT="567"><CAPTION ALIGN="TOP"><P ALIGN=LEFT><B><FONT COLOR="#ffff3f">Table 3. Assessment and treatmentsto consider in patients who present with an acute coronary syndrome. Patientswith ST-segment elevation or new BBB are candidates for the full list.</FONT></B></CAPTION><TR><TD WIDTH="474%" VALIGN="TOP" HEIGHT="138"><P><B>Initial Assessment</B></P>
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<UL> <LI>Targeted history, including AMI inclusions, thrombolytic exclusion <LI>Vital signs and focused physical examination <LI>12-lead ECG; serial ECGs as needed <LI>Chest x-ray (preferably upright) <LI>ECG monitoring</UL></TD></TR><TR><TD VALIGN="TOP" HEIGHT="138"><P><B>Initial General Treatment (Memory aid: "MONA")</B></P>
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<UL> <LI><B>Morphine</B> 2-4 mg q 5-10 min to provide adequate analgesia <LI><B>Oxygen</B> at 4 L/min; continue if arterial oxygen saturation < 90% <LI><B>Nitroglycerin</B> sublingual or IV; test for Prinzmetal's angina, reversible spasm; has anti-ischemic, antihypertensive effects <LI><B>Aspirin</B> 160-325 mg (chew and swallow)</UL></TD></TR><TR><TD VALIGN="TOP" HEIGHT="262"><P><B>Specific Treatments</B></P>
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<UL> <LI><B><FONT COLOR="#ffffff">Reperfusion therapy:</FONT></B> goals <UL> <LI>Thrombolytic agents: door-to-needle time < 30 min <LI>Primary PTCA: door-to-dilation time < 60 min </UL> <LI><B><FONT COLOR="#ffffff">Conjunctive therapy</FONT></B> (combined with thrombolytic agents) <UL> <LI>Aspirin <LI>Heparin (especially with TPA) </UL> <LI><B><FONT COLOR="#ffffff">Adjunctive therapies</FONT></B> <UL> <LI>ß-Adrenoceptor blockade if eligible <LI>IV nitroglycerin (for anti-ischemic and antihypertensive effects) <LI>ACE inhibitor (especially large anterior wall MI, heart failure without hypotension [SBP > 100 mm Hg], previous MI) </UL></UL></TD></TR></TABLE>SBP indicates systolic blood pressure.</BODY></HTML>
