Our next video is going to be acute coronary syndromes for ACS. Now some things to keep in mind with the ACS is we need to identify what's going on with our patients. So let's talk about those. First of all, we'll talk about chest pain. Now chest pain is often referred to as angina. We have two forms of angina.
Do you remember what they are? stable and unstable. So stable angina is predictable. If I go run a marathon, my chest is probably going to start hurting and I need to stop and maybe the pain hopefully goes away. unstable angina, you're not expecting it to happen. You may be just sitting or relaxing or not doing anything, and all of a sudden that chest pain or that feeling comes on, that's far, far more dangerous, but we need to recognize whether it's either stable or unstable angina.
Now the most important diagnostic tests that we need to perform on people If they're showing signs of ACS is going to be a 12 lead EKG, yes, we have to get a set of vital signs, I'd love us to get that sample history as well. But we have to get a 12 lead EKG, because what we're looking to rule out is a STEMI STEMI ST segment elevation myocardial infarction. And keep in mind, we can only see a STEMI on an EKG tracing. If and what we're looking for is that ST segment elevation in two or more leads or views of the heart that are friends with each other. If we see that elevated, we can say okay, it's a STEMI. However, that EKG tracing is only a six second snapshot of what's going on with the cardiac cycle.
So we may not see that ST segment elevation, but however, in a clinical setting, pretty much anybody who's getting an EKG performed on them is also going to get their blood taken. And what they're looking for is that cardiac marker of the proponent enzymes and if that shows, if the proponents are elevated that can suggest They did have a heart attack, but we can't call it a STEMI we have to call it a non STEMI. Because we didn't see it on an EKG tracing. So just know the difference between those two. Now, a way for us to remember how to treat our patient who's showing signs of acute coronary syndromes, is going to be using a mnemonic called Mona. Now we don't have to or we shouldn't treat our patient in the order of Mona.
It's just a way for us to remember what we need to do. But two different things are happening all at once. But M stands for morphine. morphine is a fantastic drug, it does three things for our patient, it's going to help reduce pain. It's also going to be so dilate, that increases oxygen and blood flow to the cardiac tissue of the heart muscle. And it's also going to give the patient a calming effect.
O stands for oxygen. Remember our two sets if there's if they're between 94 and 99%. On room air, additional oxygen is not is not indicated at this point, less than 90 For absolutely getting some oxygen make them feel good and stands for nitroglycerin or nitrates. The most common that we'll use is going to be the sublingual or the spray. And that is a very potent vasodilator that can help increase oxygen and blood flow to the heart muscle and therefore decrease pain. But we also need to make sure of a couple of things are some pretty big contraindications to administering nitroglycerin.
One of them is going to be hypotension if your patient is hypotensive nitroglycerin is contraindicated because it is if they so dilator, and we could tank their blood pressure and cause more problems. Another thing to consider is going to be Edy medication use or phospho diaster race inhibitors. These are commonly used for eating medications in the male population. If your patient has taken one of those pills in the last 24 to 48 hours, the nitroglycerin is pretty much going to be contraindicated because of what it's going to do to the blood pressure, we can really take them out. And the third and final thing we need To think about is we should not use nitroglycerin. If the patient or we suspect the patient is having a right sided EMI, or right ventricular involvement, if you suspect or no any one of these threes in any one of these three, nitroglycerin is contraindicated.
And the last we'll talk about is aspirin. Aspirin is going to act as an antiplatelet or an anti aggregate, it is there to help thin the blood and prevent further clots from sticking to the gloomy clot that's already started to form in the cardiac system. So the typical dose for aspirin is 160 to 325 milligrams. And that's obviously we wouldn't give them that if they are allergic or have a true aspirin allergy. Or if you see an active gi bleed either upper or lower, might want to stay away from that aspirin. But regardless, once we see what's going on, if they're having a heart attack, whether it's a STEMI or a non STEMI.
We need to get into the hospital quickly and they're going to go up to the cath lab and get PCI percutaneous coronary enter pension