Emergency Department
Chest Pain STEMI Orders
A. PATIENT CARE
 Cardiac Monitor
 Vital signs per chest pain routine
 Pulse Oximeter checks
 IV access
 Neurological checks every 2 hours
 Activity: bedrest with bathroom privileges as tolerated
B.

NUTRITION
 NPO
IF Acute Myocardial Infarction (AMI):
 Sodium Chloride 0.9% flush 3 mL q8h
 Aspirin 162 mg PO (2 baby chewed) one time only OR
 Aspirin 300 mg PR one time only, as soon as possible.
 If allergic give Clopidogrel (Plavix) 300 mg PO x 1
 Start 2 IVs Normal Saline @ TKO
 Notify Cath Lab team for primary angioplasty








Abciximab (Reopro) 0.25 mg/kg IV bolus over 1-2 minutes
Abciximab (Reopro) drip at 10 mcg/min. If patient weighs <80 kg, use 0.125 mcg/kg/min up to max. of 10 mcg/min
Heparin bolus (60 units/kg) before Cath Lab
Metoprolol (Lopressor) 5 mg IV over 2 min x 3 doses at 5 minutes intervals (total 15 mg over 15 min)
Metoprolol (Lopressor) 50 mg PO BID. First PO dose to be given 10 minutes after final intravenous dose. (Continue
upon transfer to floor)
Morphine Sulfate 2-4 mg IV q 10min PRN chest pain
Nitroglycerin Infusion 10 mcg/min titrate to pain & SBP > 90 mm Hg (Continue upon transfer to floor)


EKG 12 lead STAT
Transfer to Cath Lab with old charts
IF Patient is not a candidate for immediate (<1 hour) primary PTCA:
 Neuro Assessment: Obtain baseline neuro exam before administering TNK
 Initiate TNK, if eligible (Contraindications: IF received Reopro, BP > 180/110, trauma/recent surgery within 2 months, h/o CVA,
active internal bleeding, intracranial neoplasm, AV malformation, aneurysm, known bleeding diathesis)
Use dose chart below to determine dose:
Patient weight ___________ (indicate kg or lb)
Patient specific dose ___________ mg (NOT TO EXCEED 50 mg)
Administer as a single IV bolus over 5 seconds, one time only
Patient Weight
kg
< 60
60 - 69
70 - 79
80 - 89
 90
lbs
<132
132-153
154-175
176-197
198
TNK
(mg)
30
35
40
45
50


Heparin bolus 60 units/kg (max 4000 units if patient > 70 yo)
Heparin infusion 12 units/kg/hr (max 1000 units/hr if patient > 70 yo)


EKG 12 lead 90 minutes after thrombolytic therapy
Admit to CCU with old charts
Volume TNK to be
administered (ml)
6
7
8
9
10
FAIRVIEW HEALTH SYSTEM-PHYSICIAN ORDERS
FORM #476557
SEP/2003
EMERGENCY DEPARTMENT CHEST PAIN STEMI ORDERS
ORIGINAL: Medical Record
COPY: Pharmacy
Page 1 of 2
D. LABS STAT
 Basic Metabolic Panel (includes: sodium, potassium, CO2, glucose, BUN, Creatinine, calcium, anion gap)
 Hemoglobin
 Troponin I
 Myoglobin
 INR/PTT
 Hemogram Diff with Platelet (CBC)
Cardiac Markers:
 Troponin I 6 hours after initial level
 Troponin I 8 hours after initial level
E. DIAGNOSTIC IMAGING
 Chest X-Ray PA/Lat STAT
F. RESPIRATORY THERAPY

Nasal O2 at 2-4 L/min to keep O2 sats >94%
MD SIGNATURE____________________________PAGER #__________________DATE:________________
FAIRVIEW HEALTH SYSTEM-PHYSICIAN ORDERS
FORM #476557
SEP/2003
EMERGENCY DEPARTMENT CHEST PAIN STEMI ORDERS
ORIGINAL: Medical Record
COPY: Pharmacy
Page 2 of 2