IV, O2, monitor and EKG within 5 minutes of arrival
Note: Hospital is graded on administration of ASA/Beta Blockers- document reason for withholding (vitals; allergy; taken at home prior to arrival; other contraindications)
ASA 81mg x 4 baby aspirins PO (chewed)
-Plavix 300mg PO if severely allergic to ASA
Plavix 300mg PO
-Since plavix should be avoided in patients who will need a CABG and we cannot predict who these patients will be prior to cath lab, ask the admitting cardiologist if they desire plavix in addition to ASA
NTG 0.4mg (one tab) SL q5min prn x 3-4
-If now pain free can usually place on Nitropaste 1 inch for continued preload reduction after SLNTG.
NTG IV—start at 10-20mcg/min and slowly increase
-IV is best for unstable pts who may not tolerate large SL dose OR
-For patients that are not pain free after SL NTG
-Remember than SL NTG is 400mcg over 5min so it delivers approx 80mcg/min of NTG
-Note Christ Medical Center Code 60 criteria (STEMI) requires IV NTG (not sublingual)
-Note Christ Medical Center CHF protocol requires IV NTG (not sublingual) since it is easily titratable and desired 20% decrease in mean arterial pressure can be more easily achieved
Lopressor (Metoprolol) 5mg IV x 3 q 5min prn HR > 60 and SBP >100 or 25 PO x 1
-Note Christ Medical Center Protocol requires IV metoprolol for Code 60 but may give PO for UA/NSTEMI
Lovenox 1mg/kg SQ after normal CXR and no blood on rectal exam
-Lovenox and lopressor only for suspected UA/NSTEMI (not atypical CP)
-Preferred over Heparin. Heparin preferred if creatinine >1.6 or in STEMI protocol
Heparin 60units/kg bolus (max 4,000 units) followed by 12units/kg/hr (max 1,000 units/hr)
-Note PE/DVT dose is larger (80 units/kg followed by 18 units/kg/hr)
-Heparin preferred over lovenox if there is a relative contraindication (ie. slightly guaic positive) because the drip can be turned off
Eptifibatide (Integrilin) (GPIIb/IIIa receptor blocker)
-Evidence for use constantly changing, use in consultation w/cardiologist
-Probably beneficial if pt will be going to the cath lab
-Contraindication (Creatinine >4.0); recent surgery; BP >180/110; low platelets; bleeding diathesis