Acute Coronary Syndrome Orders

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

Diet

 * cardiac diet
 * food that can release the blockage of the artery

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 q3h x 3 to rule out Acute MI and continued until levels peak.

Cardiac

 * fasting lip id 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