What are the key points to cover in a presentation on the new 2025 Acute Coronary Syndrome (ACS) guidelines for emergency physicians?

Outline for a PowerPoint Presentation on the New 2025 ACS Guidelines for Emergency Physicians

The 2025 ACC/AHA/ACEP/NAEMSP/SCAI guidelines provide critical updates to acute coronary syndrome management that will significantly impact emergency department care and patient outcomes.

Slide 1: Introduction and Overview

• Title: "2025 ACS Guidelines: Critical Updates for Emergency Physicians"
• Subtitle: Key changes in diagnosis, risk stratification, and management
• Purpose: Practical implementation in emergency settings

Slide 2: Diagnostic Approach Updates

• Early ECG acquisition (within 10 minutes of first medical contact) 1
• Interpretation standards:
  • Computer-assisted ECG interpretation permitted but only in conjunction with physician/trained provider interpretation 1
  • Prehospital notification/catheterization lab activation for STEMI 1
• High-sensitivity troponin measurement protocols 2

Slide 3: Risk Stratification Tools

• GRACE Risk Score vs. TIMI Risk Score 2
• Key components of each scoring system
• When to use which risk stratification tool
• Impact on management decisions

Slide 4: Revascularization Strategy Updates

• Complete revascularization strategy now recommended for both STEMI and NSTE-ACS 2
• Primary PCI timing goals:
  • Within 90 minutes of first medical contact (120 minutes for transfers) 2
  • Fibrinolysis if PCI not feasible within 120 minutes 2
• Non-culprit lesion management (single procedure vs. staged) 2

Slide 5: Antiplatelet Therapy

• Initial aspirin loading dose (162-325mg) followed by daily low-dose (75-100mg) 1
• P2Y12 inhibitor selection:
  • Preference for ticagrelor or prasugrel over clopidogrel in PCI patients 2
  • Considerations for special populations
• Duration of therapy recommendations

Slide 6: Procedural Considerations

• Radial approach preferred over femoral access to reduce bleeding, vascular complications, and mortality 2
• Vascular access management
• Bleeding risk reduction strategies

Slide 7: Pain Management in ACS

• Updated medication recommendations:
  • Nitroglycerin dosing and contraindications
  • Opioid considerations (morphine, fentanyl)
  • Caution regarding potential delay of P2Y12 inhibitor absorption 1
• Medication dosing table for quick reference

Slide 8: Oxygen Therapy Updates

• Targeted oxygen therapy for hypoxemic patients (SpO2 <90%) 1
• Avoiding routine supplemental oxygen in normoxemic patients
• Monitoring recommendations

Slide 9: Post-Cardiac Arrest Management

• Temperature control recommendations:
  • Constant temperature between 32°C and 37.5°C for patients not following commands 1
  • No routine active/passive rewarming faster than 0.5°C per hour for spontaneous hypothermia 1
• Coronary angiography indications post-ROSC:
  • Recommended for STEMI, shock, electrical instability, or ongoing ischemia 1
  • Not recommended over delayed/selective strategy for other post-ROSC patients 1

Slide 10: Extracorporeal Support

• ECPR recommendations for refractory cardiac arrest 1
• Patient selection criteria
• System requirements for implementation
• Microaxial flow pump considerations 2

Slide 11: Transitions of Care

• Medication reconciliation
• Cardiac rehabilitation referral process
• Follow-up timing and components
• Secondary prevention strategies 2

Slide 12: Special Populations

• Geriatric considerations
• Renal dysfunction
• Anemia management (transfusion thresholds) 2
• Pregnancy

Slide 13: Quality Metrics for ED Management

• Door-to-ECG time (<10 minutes)
• Door-to-needle time for fibrinolysis (<30 minutes)
• First medical contact to device time for PCI
• Key documentation elements

Slide 14: Case Scenarios

• STEMI with clear indication pathway
• NSTEMI with risk stratification challenges
• Post-cardiac arrest with ACS
• Transfer considerations for non-PCI centers

Slide 15: Implementation Strategies

• ED protocols and order sets
• EMS coordination
• Catheterization lab activation process
• Quality improvement monitoring

Slide 16: Key Takeaways

• Complete revascularization strategy for STEMI and NSTE-ACS
• Preference for ticagrelor/prasugrel over clopidogrel
• Radial approach over femoral access
• Targeted temperature management between 32°C-37.5°C post-arrest
• Selective coronary angiography post-ROSC

Slide 17: Questions & Discussion

• Contact information
• Additional resources
• QR code for guideline access