Acute coronary syndrome resident survival guide: Difference between revisions
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* Ensure patency of airway, check for adequate breathing and circulation. | * Ensure patency of airway, check for adequate breathing and circulation. | ||
* Vital signs (Heart rate, blood pressure, respiratory rate, temperature, oxygen saturation) | * Vital signs (Heart rate, blood pressure, respiratory rate, temperature, oxygen saturation) | ||
* 12-lead EKG | * [[12-lead EKG]] | ||
* Cardiac enzymes (three sets of troponin, CK, CK-MB at six hour intervals; first set may be normal, but order all three sets) | * [[Cardiac enzymes]] (three sets of [[troponin]], [[CK]], [[CK-MB]] at six hour intervals; first set may be normal, but order all three sets) | ||
* Chest x-ray | * [[Chest x-ray]] | ||
* Oxygen (titrate for oxygen saturation levels >92%) | * [[Oxygen]] (titrate for oxygen saturation levels >92%) | ||
* IV access | * IV access | ||
* 325mg non-enteric coated Aspirin by mouth (or per rectum if patient cannot take orally) | * 325mg non-enteric coated [[Aspirin]] by mouth (or per rectum if patient cannot take orally) | ||
* If patient is not hypotensive and inferior myocardial ifarction has been ruled out by EKG, give 0.4mg Nitroglycerin sublingually up to three times, at 5 minute intervals, until chest pain improves. | * If patient is not hypotensive and inferior myocardial ifarction has been ruled out by EKG, give 0.4mg [[Nitroglycerin]] sublingually up to three times, at 5 minute intervals, until chest pain improves. | ||
Revision as of 19:19, 27 September 2012
Patient Presentation
The patient will most commonly present some or all of the following symptoms;
- Substernal/precordial chest pressure/heaviness/pain
- Pain in the shoulder or arm
- Nausea and/or vomiting
- Shortness of breath
- Diaphoresis
- Complaints of "heartburn"
- Dizziness
- Palpitations
Initial Evaluation and Orders
- Ensure patency of airway, check for adequate breathing and circulation.
- Vital signs (Heart rate, blood pressure, respiratory rate, temperature, oxygen saturation)
- 12-lead EKG
- Cardiac enzymes (three sets of troponin, CK, CK-MB at six hour intervals; first set may be normal, but order all three sets)
- Chest x-ray
- Oxygen (titrate for oxygen saturation levels >92%)
- IV access
- 325mg non-enteric coated Aspirin by mouth (or per rectum if patient cannot take orally)
- If patient is not hypotensive and inferior myocardial ifarction has been ruled out by EKG, give 0.4mg Nitroglycerin sublingually up to three times, at 5 minute intervals, until chest pain improves.