Acute Coronary Syndrome Orders

Admission

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

Diet

• cardiac diet

Activity

• bed rest

Vitals

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

Investigations

• 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

• Acute coronary syndrome

Other OSCE Modules