Archive:Acute coronary syndrome orders

Admission

Admit to Dr. _________

Diet

• cardiac diet

Activity

• bed rest

Vitals

• telemetry
• continuous monitoring ECG

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

• 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 81 mg po qd

Blood

• catheter lab (door to balloon time < 90 minutes)
• thrombolytic therapy 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
• NG 0.3 mg SL PRN

Other OSCE Modules

Observed structured clinical examination

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