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]]) | ||
* [[EKG|12-lead EKG]] | * [[EKG|12-lead EKG]] (compare with old EKG if possible) | ||
* [[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 [[ | * 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 [[ | * 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 19:22, 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 (compare with old EKG if possible)
- 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.