Acute coronary syndrome resident survival guide

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.