Cox Health
Springfield, Mo
Chest Pain Observation Unit
Clinical Pathway-Possible Angina Admission Orders
Moderate to Low Risk
Start Date________________________Start Time_______________________am/pm (circle one)
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Transfer to Chest Pain Observation Unit
Diagnosis: Chest Pain, not otherwise specified.
Condition: Stable.
Notify Chest Pain Observation Physician of Location.
Vital Signs: q 2 hours x 4 hours, then advance to q 8 hours.
Activity: Bedrest with bathroom privileges.
Allergies: ______________________________
Telemetry Monitor
Pulse Ox with Vital Signs
Diet: ___ Regular ___NPO ___Carb Consistant ___Low Chol ___ NPO after MN for stress test in am
IV Saline Lock
Meds:
_____ ASA 81 mg p.o. q. d. unless contraindicated
_____ NTG 0.4 mg SL q 5 min x 3 prn chest pain
_____ Acetaminophen 650 mg p.o. q 6 hours prn.
_____ Home Meds: ID/Document home meds on admission database.
_____ Cardiology PRN Medications
_____ Angina Management Orders
_____ Other: _______________________________________________
_____ Other: _______________________________________________
Labs:
_____ Confirm 0 hour Troponin I drawn at ____:____ am/pm
_____ 4 hour Troponin I draw at ____:____ am/pm
_____ 8 hour Troponin I draw at ____:____ am/pm
_____ Lipid Profile (draw and Hold)
_____ Lipid Profile (draw and RUN)
_____ Other ________________________________________________
ECG:
_____Repeat ECG at 6 hours post initial, time ____:____ am/pm
_____Obtain ECG if patient complains of chest pain.
In-Hospital Provocative Testing:
_____ Exercise Sestamibi Stress Test
_____ Adenosine Sestamibi Stress Test
_____ Dobutamine Sestamibi Stress Test
_____ Dobutamine Stress Echo
Contact Chest Pain Observation physician when Results of Provocative Testing Completed.
Notify MD:
1) If Condition worsens
2) If discharge criteria are met
3) If cardiac enzymes return positive.
4) When Observation period is complete.
Signature of Attending Physician
Date/Time
Cox Health
Springfield, Mo
Emergency Department Evaluation Chest Pain Observation Unit
Pre-Admission Criteria and Checklist
Clinical Pathway-Possible Angina
Observation Plan (Max 23 Hours)
Moderate/Low Risk
Inclusion Criteria:
Cardiac Risk Factors:
_____ High Cholesterol
_____ Age (M>60, F>70)
Exclusion Criteria:
Pre-Admission Checklist:
ALL PATIENTS:
__X__ Normal Baseline or Nonspecific ECG and
__X__ Negative Cardiac Enzymes and
_____ Atypical Anginal Symptoms or
_____ < 3 Cardiac Risk Factors
_____Diabetes Mellitus
_____Tobacco Use
_____Hypertension
_____Known ASCVD
_____Fm Hx ASCVD
_____Continued/Unrelieved Chest Pain
_____ECG changes of Acute MI or Ischemia
_____ECG changed from Baseline
_____Left Bundle Branch Block
_____New onset or uncontrolled Arrhythmia
_____Altered Mental Status
_____Congestive Heart Failure
_____Recent Cocaine Use
_____Abnormal Vital Signs: (Temp>101, Pulse>120,RR > 40 per minute,
Systolic BP > 180 or < 90, Diastolic BP > 110)
List Allergies
__________________________________________________________
_____ EKG
_____ Cardiac Monitor
_____ Pulse Ox
_____ B/P __________
_____ ASA given in ER or by EMS unless contraindicated
_____ O2 at 2L/NC
_____ CBC
_____ Chem Panel
_____ IV Access
_____ CXR
_____ Negative Troponin
The patient satisfied the inclusion/exclusion criteria and the pre-admission checklist of this pathway. I personally
evaluated the patient and (s)he is eligible for transfer for observation care in the Chest Pain Observation Unit
(CPOU).
Attending ER Physician
Date/Time