ED STEMI Acute MI

Patient Name: HEOTEST, TOMMY  Age: 34 years  Gender: M  Location: 2WB W235  01  Height: 185.4 cm  Weight: 79.5 kgs  BMI: 23.1  Serum Creatinine: ?? Date Drawn: 09/09/2011 06:35am  Ordering Clinician: PATERSON

Select the Patient's Location for Lab Label printing:

MAIN ED   PRIORITY   ECC/Chest Pain Center

Laboratory
Complete blood cell count with automated differential Complete blood cell count without differential Comprehensive metabolic panel (CMP) Basic metabolic panel (BMP) Hepatic panel Lipase level, serum Troponin Prothrombin time (PT) with international normalized ratio (INR) Partial thromboplastin time (PTT), activated Pregnancy test, serum Pregnancy test, urine D-dimer CK with CKMB CK total

Radiology
Chest single view Portable To radiology chest pain

Nursing/Procedures
Insert IV with site care management Insert second large bore IV with site care management 12-lead EKG CHEST PAIN Telemetry monitoring Oxygen -Pulse oximeter -Initiate oxygen protocol Old EKG Notify cardiologist on call/cardiac cath lab immediately of AMI Place checklist for thrombolytic contraindications on the chart

IV Fluids
NS bolus 1 L 500 ML 250 ML IV NS 125 ML/HR 50 ML/HR 75 ML/HR 100 ML/HR 150 ML/HR IV

Medications

aspirin chewable (if not allergic or if not taken prior to arrival) 324 MG 81 MG 162 MG ORAL; chew and swallow nitroglycerin [NITROSTAT] 0.4 MG SL Q5MIN PRN for 3 DOSES nitroglycerin infusion [TRIDIL] 5 MCG/MIN IV CONTINUOUS TITRATE to a maximum of 200 MCG/MIN to pain free, keep SBP greater than 100 MMHG morphine 2 MG 1 MG 4 MG 5 MG 6 MG 8 MG 10 MG IV IM for severe pain; may repeat dose times 1 in 15 MIN if pain not relieved no repeat dose clopidogrel [PLAVIX] 75 MG 300 MG 600 MG ORAL metoprolol tartrate [LOPRESSOR] 5 MG IV EVERY 5 MIN for 3 DOSES keeping SBP greater than 90 MMHG and pulse greater than 60 BPM ondansetron [ZOFRAN] 4 MG 0.5 MG 1 MG 1.5 MG 2.5 MG 8 MG IV SL ONCE for nausea/vomiting

Anticoagulants: Unfractionated Heparin This will follow heparin protocol, yet to be developed
Do not exceed 4000 Unit bolus maximum
heparin 60 UNIT/KG IV ONCE initial dose heparin 12 UNIT/KG/HR 16 UNIT/KG/HR IV CONTINUOUS maintenance dose; dose adjustment per heparin protocol

Other
Initiate heparin protocol Initiate bivalirudin [ANGIOMAX] protocol Initiate alteplase [ACTIVASE] protocol

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