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STEMI: INITIAL MANAGEMENT ORDER TEMPLATE

(Referenced Version)

This template lists initial elements, drugs, doses, and strategies that should be highly considered when creating admission order sets based upon recent clinical practice guidelines, medication package inserts, and emerging evidence.

DEMOGRAPHICS

Top of Form

Age ___________ years Weight __________ kg

DIET ORDERS

( NPO

( 2 gm sodium restricted/low cholesterol/low fat

( Diabetic _________________ calorie ADA

( Other (specify) _____________________________

ACTIVITY ORDERS

( Bed rest

NURSING1(pg e35)

( Continuous ECG monitoring

( Supplemental O2 to keep arterial saturation > 90%

( Nitroglycerin Protocol: PRN use of 0.4mg q5 min for chest pain

MEDICATION ALLERGIES

( Specify: _______________________________________ Reaction (if known): ___________________________

DIAGNOSTIC STUDIES

( 12-lead ECG FOR RECURRENT CHEST PAIN

( 12-lead ECG IN AM (____/___/___ ___:___ AM)

LABORATORY STUDIES

ROUTINE LABS

Chemistry panel: ( NOW ( DAILY IN AM

CBC: ( NOW ( DAILY IN AM

Fasting lipid panel: ( IN AM

HbA1c: ( IN AM

Calculate creatinine clearance (CrCl): _______ml/min

CrCl ml/min = (140 - age) X weight (kg)/(serum creatinine X 72) multiply by 0.85 if female

SELECT REPERFUSION STRATEGY

( Fibrinolytic Therapy: Within 12 hours of symptom onset and primary PCI cannot be achieved in 0.24 sec, second or third degree AV block, active asthma, or reactive airway disease.[xiv]

( ACE-I or ARB: Drug: ____________________ _______ mg _____ times day (start 12 hours after admission).

( Statin: Drug: __________________________ ________ mg once daily (regardless of LDL)

( Stop NSAIDS (except aspirin)

( GI Prophylaxis (with history of GI bleeding)

Drug: _________________________ ___________ mg _____________ times day

FIBRINOLYTIC THERAPY ORDERS (Goal Door to Needle 180/110 mm Hg

Any cerebrovascular events < 1 year Use of anticoagulants with INR > 2.0

Active internal bleeding Noncompressible vascular punctures

Known intracranial neoplasm Prolonged CPR (> 10 minutes)

Suspected aortic dissection Prior gastrointestinal hemorrhage

Pregnancy or Menstruation

Trauma < 2 to 4 weeks prior

Major Surgery 90 kg, give 50 mg single IV bolus.[xix]

ANTICOAGULANT THERAPY (Choose ONE with fibrinolytics):

( Unfractionated Heparin:

Bolus: 60 U/kg IV (not to exceed 4000 U regardless of weight)

Infusion: 12 U/kg/hr IV (not to exceed 1000U/hr regardless of weight) to goal PTT 1.5 to 2.0 times local reference standard; check PTT in 6 hours and adjust heparin as indicated

Note: Not to be continued for > 48 hours unless otherwise indicated.[xx]

OR

( Enoxaparin*: Bolus: 30 mg IV (no IV bolus if age >75 years)

Maintenance: 1mg/kg subcutaneously every 12 hours, first dose 15 minutes after bolus (if age >75 years give 0.75 mg/kg every 12 hours with no bolus; if CrCl 75 years)

Maintenance: 1 mg/kg subcutaneously every 12 hours, first dose 30 minutes after bolus (if age > 75 years, give 0.75 mg/kg every 12 hours with no bolus; if CrCl ................
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