Acute Coronary Syndrome Orders

AdmissionEdit

Admitting Physician:_______________________
Attending Physician:_______________________
Family/PC Physician:_______________________

DietEdit

  • cardiac diet

ActivityEdit

  • bed rest

VitalsEdit

  • telemetry
  • continuous monitoring ECG
  • Vitals with pulse oximetry q4h

InvestigationsEdit

  • Routine - CBCD
  • renal → creatinine, lytes, total protein, Mg, urine analysis
  • liver → albumin, PT, ALKP, ALT, bilirubin
  • CXR daily x 3 days

Acute Coronary SyndromeEdit

  • 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.

CardiacEdit

  • fasting lip id profile in AM
  • HgBA1C for diabetics
  • fasting homocysteine
  • HgB, plt q2d (for patients on unfractionated)

DrugsEdit

MONA - 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

BloodEdit

  • 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

MaintainEdit

  • Lipitor
  • cardiac rehabilitation to see
  • Nitroglycerin 0.3 mg sublingual q 5 min x3 PRN chest pain


See alsoEdit

Other OSCE ModulesEdit