Acute Coronary Syndrome Orders
Admission
editAdmitting Physician:_______________________
Attending Physician:_______________________
Family/PC Physician:_______________________
Diet
edit- cardiac diet
- food that can release the blockage of the artery
Activity
edit- bed rest
Vitals
edit- telemetry
- continuous monitoring ECG
- Vitals with pulse oximetry q4h
Investigations
edit- Routine - CBCD
- renal → creatinine, lytes, total protein, Mg, urine analysis
- liver → albumin, PT, ALKP, ALT, bilirubin
- CXR daily x 3 days
Acute Coronary Syndrome
edit- CK q8h (x 5 for MI, x3 to rule out MI)
- troponin I q3h x 3 to rule out Acute MI and continued until levels peak.
Cardiac
edit- fasting lip id profile in AM
- HgBA1C for diabetics
- fasting homocysteine
- HgB, plt q2d (for patients on unfractionated)
Drugs
editMONA - Should be completed at the time of admission.
- Morphine
- Oxygen at 3L/min by NC prn, titrate to saturation >90%
- Nitrate therapy IV (25 mg in 250 mL D5W) or NG patch
- ASA 160 mg po chew and swallow, then enteric coated ASA (ECASA) 81 mg po qd
Blood
edit- catheter lab (door to balloon time < 90 minutes)
- thrombolytic therapy (ie tenecteplase) as per Acute MI protocol (if STEMI) (< 30 minutes)
- Clopidogrel 600 mg po STAT, then Clopidogrel 75 mg po qd
- enoxaparin 1 mg/kg sc q12h to a max of 100 mg/dose
↓O2 NEED
- metoprolol 5 mg IV q5 min x 3; followed by 25 mg po q6h x 48h, then 100 mg po q12h
- ACEi
Maintain
edit- Lipitor
- cardiac rehabilitation to see
- Nitroglycerin 0.3 mg sublingual q 5 min x3 PRN chest pain