Acute Coronary Syndrome Orders

## Contents

* 1 Admission
* 2 Diet
* 3 Activity
* 4 Vitals
* 5 Investigations
* 6 Acute Coronary Syndrome
* 7 Cardiac
* 8 Drugs
* 9 Blood
* 10 Maintain
* 11 See also
* 12 Other OSCE Modules

## Admission[edit | edit source]

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

## Diet[edit | edit source]

* cardiac diet

## Activity[edit | edit source]

* bed rest

## Vitals[edit | edit source]

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

## Investigations[edit | edit source]

* 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 | edit source]

* 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 | edit source]

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

## Drugs[edit | edit source]

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[edit | edit source]

* 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 | edit source]

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

## See also[edit | edit source]

* Acute coronary syndrome

## Other OSCE Modules[edit | edit source]

* v
* t
* e

Objective 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
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