Monitoring

Continuous ECG

Blood Pressure


Investigation

Serial 12-lead ECG to exclude MI (advise posterior leads too)

Troponin I/T, CPK to exclude MI

U&E + FBC


Treatment - immediate

GIVE high concentration oxygen

GIVE oral aspirin 300mg chewed if not already taking aspirin

GIVE diamorphine 2.5-5mg + metoclopramide 10mg IV

GIVE nitrate if systolic BP >90mmHg [Check for Viagra use first]

 

2 tablets / puffs sublingual GTN then GTN infusion OR

 

Buccal suscard 3 mg

 

Remember: tolerance to nitrates occurs within 24 hours

START

 

Enoxaparin 1mg/kg SC every 12 hours

 

Note: not all LMWHs are licensed for unstable angina

Consider

GPIIb/IIIa inhibitors


Treatment - continuing

This may involve the use of Beta-blockers, calcium antagonists and potassium channel activators and is best determined by the consultant responsible for the patient

Adapted from Frimley Park Hospital guidelines

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