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SINDROM KORONER AKUT Merujuk pd sekumpulan keluhan dan tanda klinis yang sesuai dengan iskemia miokard akut Mencakup Infark miokard akut ( dgn elevasi /depresi segmen ST , gelombang-Q dan non gel Q) dan angina tidak stabil ( UAP)
Immediate Assessment in ED
Vital signs, including blood pressure Oxygen saturation IV access 12-leads ECG Brief, targeted history and physical exam (to identify reperfusion candidates) Fibrinolytic check list; check contraindications Obtain initial cardiac markers Portable Chest X-ray < 30 min. Assess for the following : -Heart rate > 100 bpm and SBP < 100 mmHg -Pulmonary edema/rales or -Signs of shock any of these conditions is present, consider triage to a facility capable of cardiac catheterization and revascularization
If
LOKASI ISKEMIA / INFARK Inferior Anteroseptal Anterior Anterior ekstensif Lateral Apikal Posterior Ventrikel kanan
Fibrinolytics
Absolute Contraindications :
-Any prior intracranial hemorrhage (ICH) -Known structural cerebral vascular lesion (eg. AVM) -Known malignant intracranial neoplasma -Ischemic stroke within 3 month EXCEPT acute ischemic stroke within 3 hrs -Suspected aortic dissection -Active bleeding or bleeding diasthesis -Significant closed head trauma or facial trauma within 3 months
Fibrinolytic
Relative Contraindications :
- Check your handbook !!!
Thank you