Available at ALL facilities Non Categorized SUB ED Chest Pain: STEMI Protocol(SUB)* SUB ED Chest Pain: STEMI Protocol Lab Orders(SUB)* ED Rainbow Tubes(SUB)* ***Reminder: Order ED Rainbow Tubes (SUB) as a separate form*** Quality Measures AMI Reason for PCI Delay Medications ***(NOTE)*** ASPIRIN -- MUST Select ONE aspirin 324 mg tab chew PO ED_ONCE (DEF)* Comments: Administer 4 tablets of 81 mg total dose= 324 mg 162 mg tab chew PO ED_ONCE Comments: Administer 2 tablets of 81 mg total dose= 162 mg 300 mg supp PR ED_ONCE Comments: If unable to take by mouth Reason Aspirin Not Given on Arrival ***(NOTE)**** **Nitroglycerin*** ***(NOTE)*** ** Caution with administration of nitroglycerine if SBP less than 90mmHg or patient took medication for erectile dysfunction within 24 hours Nitroglycerin 50 mg / Dextrose (iso-osmotic) 250 ml IV bottle Rate: 5 mcg/min Comments: Begin infusion at 5 mcg/mintitrate by 5 mcg/min every 3-5 minutes to chest pain reliefmaximum = 400 mcg/min nitroglycerin 0.4 mg tab subling SUBLING Q5MINS Int, PRN Chest Pain, Clinical Instructions: 3 dose Anticoagulants Tenecteplase (TNK-ase) for Myocardial Infarction(SUB)* ***Reminder: Order Tenecteplas (TNK-ase) for Myocardial Infarction (SUB) as a separate form*** CARD Aggrastat (tirofiban) IV Bolus and Infusion(SUB)* ***Reminder: Order CARD Aggrastat (tirofiban) IV Bolus and Infusion (SUB) as a separate form*** MED High Intensity Heparin(SUB)* ***Reminder: Order MED High Intensity Heparin (SUB) as a separate form*** MED Low Intensity Heparin(SUB)* ***Reminder: Order MED Low Intensity Heparin (SUB) as a separate form*** Reason for Fibrinolytic Therapy Delay Page 1 of 5
Antiemetics promethazine (Phenergan) 12.5 mg inj IV PUSH ED_ONCE, PRN Nausea/Vomiting Comments: If the patient has an IV infusing, the promethazine should be mixed in 20 ml of saline and administered slowly over at least 3 minutes at the port furthest away from the iv insertion site. If the patient does not have an IV infusing, the promethazine should be mixed in 50 ml bag of saline and administered over 15 minutes. Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. ondansetron (Zofran) 4 mg inj IV PUSH ED_ONCE, PRN Nausea/Vomiting Comments: Unless otherwise specified, ondansetron (Zofran) serves as the first line anti-emetic. metoclopramide (Reglan) 10 mg inj IV PUSH ED_ONCE Analgesics: Opioids morphine 2 mg inj IV PUSH ED_ONCE (DEF)* 4 mg inj IV PUSH ED_ONCE hydromorphone (Dilaudid) 0.5 mg inj IV PUSH ED_ONCE (DEF)* 1 mg inj IV PUSH ED_ONCE IV Solutions Sodium Chloride 0.9% (Normal Saline Bolus) 1,000 ml IVPB bag ED_ONCE (DEF)* 500 ml IVPB bag ED_ONCE 250 ml IVPB iv ED_ONCE Sodium Chloride 0.9% (NS) IV bag 100 ml/hour (DEF)* IV bag 150 ml/hour IV bag 250 ml/hour ***(NOTE)***If extra blood tubes have been ordered use the add on blood order below ED Add on Blood in Lab BMP CBC CK CKMB Troponin, Specimen in Lab ***(NOTE)***If labs or extra blood tubes have not been ordered use the subphase below SUB ED Chest Pain: STEMI Lab Orders(SUB)* SUB ED Chest Pain: STEMI Protocol Non Categorized Quality Measures AMI Vital Signs Vital Signs Q5MINS Int Page 2 of 5
ED Cardiac Monitor Diet ED NPO Nursing Orders Initiate Protocol SUB ED Chest Pain: STEMI Protocol Notify Provider Take ECG to Physician immediately Notify Provider Notify physician immediately for worsening chest pain, unstable vital signs and changes in cardiac rhythm ED Communication Order Stat, Place call to Cardiovascular Transfer Coordinator at 904-686-5045 and notify coordinator about the patient's name, age, history, patient's private cardiologist name and the lead where the ST elevation is located Start IV/INT Start 2 peripheral IVs ***(NOTE)***ED Urine Pregnancy POC for females of child-bearing age and capacity ED Urine Pregnancy POC ED_ONCE ED Notify Provider Vital Signs Temperature > 101.5, Temperature < 98, HR > 110, HR < 60, SBP > 180, SBP < 90, RR > 20, RR < 8, SpO2 < 94 Radiology XR Chest *1 view AP Portable Chest pain, Pending Discharge - No, ED_ONCE Respiratory Pulse Oximetry (Continuous) Special Instructions: If oxygen saturation less than 94%, initiate O2 Therapy order, 1, day Comments: Q8H sensor site must be inspected. IF circulatory condition or skin integrity has changed, the sensor should be applied to a different site. O2 Therapy. Nasal Cannula, 2, Titrate to maintain oxygen saturation greater than or equal to 94% istat Notification istat Cartridge Type: Creatinine Cardiology ECG Standard ED_ONCE, Completed EKG to ED physician for immediate interpretation. Obtain Right Sided EKG if Inferior MI noted SUB ED Chest Pain: STEMI Protocol Lab Orders CBC. Page 3 of 5
Basic Metabolic Panel PT INR Lipid Profile Cardiac Enzymes Creatine Kinase Total STAT, Creatine Kinase MB STAT, Troponin STAT, +2 Hours Creatine Kinase Total Timed Study, Comments: 2 hours after initial Creatine Kinase Total +2 Hours Creatine Kinase MB Timed Study, Comments: 2 hours after initial Creatine Kinase MB +2 Hours Troponin Timed Study, Comments: 2 hours after initial Troponin SUB ED Chest Pain: STEMI Lab Orders CBC. Basic Metabolic Panel PT INR Lipid Profile Cardiac Enzymes Creatine Kinase Total STAT, Creatine Kinase MB STAT, Troponin STAT, +2 Hours Creatine Kinase Total Timed Study, Comments: 2 hours after initial Creatine Kinase Total Page 4 of 5
+2 Hours Creatine Kinase MB Timed Study, Comments: 2 hours after initial Creatine Kinase MB +2 Hours Troponin Timed Study, Comments: 2 hours after initial Troponin Page 5 of 5