General Approach to Treatment

General treatment measures for all STE ACS and high-and intermediate-risk NSTE patients include admission to hospital, oxygen administration (if oxygen saturation is low, less than 90%), continuous multi-lead ST-segment monitoring for arrhythmias and ischemia, frequent measurement of vital signs, bed rest for 12 hours in hemody-namically stable patients, avoidance of the Valsalva maneuver (prescribe stool softeners routinely), and pain relief (Figs. 8-2 and 8-3).

Because risk varies and resources are limited, it is important to triage and treat patients according to their risk category. Initial approaches to treatment of STE and NSTE ACS patients are outlined in Figure 8-1. Patients with STE are at high risk of death, and efforts to reestablish coronary perfusion, as well as adjunctive pharmaco-therapy, should be initiated immediately.

Features identifying low-, moderate-, and high-risk NSTE ACS patients are described using the thrombolysis in myocardial infarction (TIMI) risk score in Table 8-1 2

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