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Acute coronary syndrome

Start this sheet when: Chest pain or anginal equivalent (breathlessness, epigastric pain, sweating, syncope) in anyone over 30, or any diabetic or elderly patient who is 'just unwell'.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Symptom onset (clock time)

Time since door

Reperfusion window (12 h): enter symptom onset

Targets met --Breaches 0

1.Triage, pain flagged as possible ACS
≤ 5 min from door · ED KPI: triage median 5 min
Enter door time
2.12-lead ECG done and read by a doctor
≤ 10 min from door · ESC 2023 / ACC-AHA 2025: 10 min
Enter door time
3.Aspirin 300 mg chewed
≤ 20 min from door · Local target: straight after the ECG
Enter door time
4.hs-troponin (0 h) sample sent
≤ 20 min from door · Local target: with the first cannula
Enter door time
5.Reperfusion decided (cath lab called / lysis / transfer)(STEMI only)
≤ 10 min from ECG · ESC 2023: 10 min from diagnostic ECG
N/AEnter door time
6.Lysis started: door-to-needle(STEMI treated by lysis)
≤ 30 min from door · ACC-AHA 2025: 30 min
N/AEnter door time
7.Primary PCI wire crossed: door-to-device(STEMI, PCI on site)
≤ 1 h 30 min from door · ACC-AHA 2025: 90 min
N/AEnter door time
8.Left for PCI centre: door-in-door-out(STEMI transferred)
≤ 30 min from door · ACC-AHA 2025: 30 min
N/AEnter door time
9.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
10.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Repeat the ECG every 15-30 min if the first is normal and pain goes on
☐Check posterior (V7-V9) and right leads (V4R) for inferior or 'normal' ECGs
☐P2Y12: ticagrelor 180 mg for PCI; clopidogrel 300 mg with lysis (75 mg if 75+)
☐Oxygen only if SpO2 is below 90%
☐Tenecteplase by weight, half dose if 75 or older; enoxaparin or heparin with it
☐PCI centre can't reach 120 min from first contact? Lyse, then transfer
☐After lysis: ECG at 60-90 min; under 50% ST resolution = rescue PCI
☐Ayushman Bharat card and ID photographed before the transfer leaves

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Repeat the ECG every 15-30 min if the first is normal and pain goes on

☐Check posterior (V7-V9) and right leads (V4R) for inferior or 'normal' ECGs

☐P2Y12: ticagrelor 180 mg for PCI; clopidogrel 300 mg with lysis (75 mg if 75+)

☐Oxygen only if SpO2 is below 90%

☐Tenecteplase by weight, half dose if 75 or older; enoxaparin or heparin with it

☐PCI centre can't reach 120 min from first contact? Lyse, then transfer

☐After lysis: ECG at 60-90 min; under 50% ST resolution = rescue PCI

☐Ayushman Bharat card and ID photographed before the transfer leaves