The Living Guidelines: UA/NSTEMI Recommendations for Initial Evaluation, Clinical Assessment and Management Suggest Revisions to the CLASS IIa Guidelines

Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here. In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme be used. Read more about the classification scheme used by the ACC / AHA Guidelines Committee here.

Instructions on How to Edit the Guidelines:
 * Log in
 * Click on "Edit"
 * Type in changes to guidelines
 * Click "Save page" at the bottom of the page

Class IIa Guidelines

 * 1) It is reasonable for health care providers and 9-1-1 dispatchers to advise patients without a history of ASA allergy who have symptoms of ACS to chew ASA (162 to 325 mg) while awaiting arrival of pre hospital EMS providers. Although some trials have used enteric coated ASA for initial dosing, more rapid buccal absorption occurs with non enteric coated formulations. (Level of Evidence: B)
 * 2) It is reasonable for health care providers and 911 dispatchers to advice patients who tolerate NTG to repeat NTG every 5 min for a maximum of 3 doses while awaiting ambulance arrival. (Level of Evidence: C)
 * 3) It is reasonable that all pre hospital EMS providers perform and evaluate 12-lead ECGs in the field (if available) on chest pain patients suspected of ACS to assist in triage decisions. Electrocardiographs with validated computer-generated interpretation algorithms are recommended for this purpose. (Level of Evidence: B)
 * 4) If the 12-lead ECG shows evidence of acute injury or ischemia, it is reasonable that pre hospital ACLS providers relay the ECG to a predetermined medical control facility and/or receiving hospital. (Level of Evidence: B)