From the Guidelines
The best next step in the immediate management of this patient is to advise them to chew ASA (162 to 325 mg) while awaiting arrival of prehospital EMS providers. This recommendation is based on the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction 1. The guidelines suggest that symptoms of ACS should be treated with ASA as soon as possible, and that non–enteric-coated formulations are preferred due to more rapid buccal absorption. Additionally, it is reasonable for health care providers and 9-1-1 dispatchers to advise patients who tolerate NTG to repeat NTG every 5 min for a maximum of 3 doses while awaiting ambulance arrival 1. However, the most critical step is the immediate administration of ASA to reduce morbidity and mortality associated with acute coronary syndrome. Other considerations include the performance and evaluation of 12-lead ECGs in the field by prehospital EMS providers to assist in triage decisions 1. The patient should also be instructed to proceed rapidly to an ED, preferably one equipped to perform prompt reperfusion therapy, and to access the EMS system directly by calling 9-1-1 if the discomfort is moderate to severe or sustained 1. The use of thrombolytic therapy or primary PTCA may be considered based on the patient's ECG results and other factors, as outlined in the ACC/AHA guidelines for the management of patients with acute myocardial infarction 1. Overall, the key to improving outcomes in patients with suspected ACS is rapid evaluation and treatment, and the administration of ASA is a critical first step in this process. It is also important to note that the general practitioner can triage by telephone and call for an ambulance, and that a short-acting nitrate may be given if there is no bradycardia or low blood pressure, and fast acting aspirin should be given as soon as possible 1.
From the FDA Drug Label
If an acetaminophen overdose is suspected, obtain a serum acetaminophen assay as soon as possible, but no sooner than 4 hours following oral ingestion. Obtain liver function studies initially and repeat at 24-hour intervals. Administer the antidote N-acetylcysteine (NAC) as early as possible The best next step in the immediate management of this patient is to:
- Obtain a serum acetaminophen assay as soon as possible, but no sooner than 4 hours following oral ingestion
- Obtain liver function studies initially and repeat at 24-hour intervals
- Administer the antidote N-acetylcysteine (NAC) as early as possible 2
From the Research
Immediate Management
The best next step in the immediate management of this patient involves assessing and addressing their basic life-supporting functions.
- The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is a widely accepted method for initial assessment and treatment in clinical emergencies 3.
- This approach helps healthcare professionals focus on the most life-threatening problems first, which can improve patient outcomes.
- Key components of the ABCDE approach include:
- Ensuring a patent airway
- Assessing and supporting breathing
- Evaluating and maintaining circulation
- Assessing disability (neurological function)
- Ensuring exposure (removing clothing to assess for injuries)
- High-quality ABCDE skills among healthcare team members can save time and improve team performance in acute settings 3.