Archive:Acute coronary syndrome orders: Difference between revisions
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==Admission== | ==Admission== | ||
Admitting Physician:_______________________<br> | |||
Attending Physician:_______________________<br> | |||
Family/PC Physician:_______________________<br> | |||
==Diet== | ==Diet== | ||
| Line 7: | Line 9: | ||
==Activity== | ==Activity== | ||
*bed rest | *bed rest | ||
{{ntnes}} | |||
==Vitals== | ==Vitals== | ||
*[[Wikipedia:Telemetry#Medicine|telemetry]] | *[[Wikipedia:Telemetry#Medicine|telemetry]] | ||
*continuous monitoring ECG | *continuous monitoring ECG | ||
*Vitals with pulse oximetry q4h | |||
==Investigatiosn== | ==Investigatiosn== | ||
| Line 29: | Line 32: | ||
==Drugs== | ==Drugs== | ||
'''MONA''' | '''MONA''' - Should be completed at the time of admission. | ||
*'''M'''orphine | *'''M'''orphine | ||
*'''O'''xygen at 3L/min by NC prn, titrate to saturation >90% | *'''O'''xygen at 3L/min by NC prn, titrate to saturation >90% | ||
*'''N'''itrate therapy IV (25 mg in 250 mL D5W) or NG patch | *'''N'''itrate therapy IV (25 mg in 250 mL D5W) or NG patch | ||
*'''A'''SA 160 mg po chew and swallow, then enteric coated ASA 81 mg po qd | *'''A'''SA 160 mg po chew and swallow, then enteric coated ASA (ECASA) 81 mg po qd | ||
==Blood== | ==Blood== | ||
*catheter lab (door to balloon time < 90 minutes) | *catheter lab (door to balloon time < 90 minutes) | ||
*thrombolytic therapy as per Acute MI protocol (if STEMI) (< 30 minutes) | *thrombolytic therapy (ie tenecteplase) as per Acute MI protocol (if STEMI) (< 30 minutes) | ||
*[[wikipedia:Clopidogrel|Clopidogrel]] 600 mg po STAT, then Clopidogrel 75 mg po qd | *[[wikipedia:Clopidogrel|Clopidogrel]] 600 mg po STAT, then Clopidogrel 75 mg po qd | ||
*[[wikipedia:Enoxaparin|enoxaparin]] 1 mg/kg sc q12h to a max of 100 mg/dose | *[[wikipedia:Enoxaparin|enoxaparin]] 1 mg/kg sc q12h to a max of 100 mg/dose | ||
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*[[wikipedia:Lipitor|Lipitor]] | *[[wikipedia:Lipitor|Lipitor]] | ||
*cardiac rehabilitation to see | *cardiac rehabilitation to see | ||
*Nitroglycerin 0.3 mg sublingual PRN | *Nitroglycerin 0.3 mg sublingual q 5 min x3 PRN chest pain | ||
==See also== | |||
*[[Acute coronary syndrome]] | |||
==Other OSCE Modules== | ==Other OSCE Modules== | ||
{{OSCE2}} | {{OSCE2}} | ||
[[Category:Medicine]][[Category:OSCE]] | |||
[[Category:Cardiovascular Medicine]] | |||
[[Category:OSCE]] | |||
Latest revision as of 15:34, 7 June 2009
Admission
Admitting Physician:_______________________
Attending Physician:_______________________
Family/PC Physician:_______________________
Diet
- cardiac diet
Activity
- bed rest
Vitals
- telemetry
- continuous monitoring ECG
- Vitals with pulse oximetry q4h
Investigatiosn
- Routine - CBCD
- renal → creatinine, lytes, total protein, Mg, urine analysis
- liver → albumin, PT, ALKP, ALT, bilirubin
- CXR daily x 3 days
Acute Coronary Syndrome
- CK q8h (x 5 for MI, x3 to rule out MI)
- troponin I q8h
Cardiac
- fasting lipid profile in AM
- HgBA1C for diabetics
- fasting homocysteine
- HgB, plt q2d (for patients on unfractionated)
Drugs
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
Blood
- 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
- Lipitor
- cardiac rehabilitation to see
- Nitroglycerin 0.3 mg sublingual q 5 min x3 PRN chest pain
See also
Other OSCE Modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence