General measures |
Ventilation support to correct hypoxemia and, in part, acidosis |
Optimize intravascular volume |
Sodium bicarbonate only for severe metabolic acidosis (arterial pH less than 7.10 to 7.15) |
Aspirin |
Intravenous heparin |
Possible glycoprotein IIb/IIIa inhibitor with NSTEMI |
Insertion of pulmonary artery catheter |
Specific measures |
Pharmacologic support |
Sympathomimetic inotropes (eg, dopamine) |
Norepinephrine (for refractory hypotension) |
Mechanical support |
IABP, usually combined with percutaneous coronary intervention or coronary artery bypass graft surgery or possible thrombolytic therapy |
Newer devices |
Left ventricular or biventricular assist devices |
Percutaneous cardiopulmonary bypass |
Reperfusion/revascularization |
Primary percutaneous coronary intervention |
Coronary artery bypass graft |
Thrombolytic therapy for patients not receiving PCI in a timely manner |
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