Acute Coronary Syndrome Medications (Unstable angina, NSTEMI, STEMI)

Acute Coronary Syndrome Admission Orders

1. Admit to the CCU
2. Condition: Stable (Critical, Unstable)
3. Diagnosis ACS
4. Vitals q15m x4, then q1hr

1. Activity Bedrest with bathroom privileges. Elevate the head of bed prn
2. Nursing monitor for CP, SOA, arrhythmias. Notify MD for changes in vitals, pain unrelieved by medication, EKG changes
3. Diet NPO until stable, then Low Sodium, Low fat, Health heart diet, record % of meal consumed
4. IVFs normal saline at 75 cc/hr until taking greater than 1000 cc fluids orally
5. Studies
   • EKG now
   • CXR now
   • EKG q6h or sooner if chest pain recurs
   • Echo to assess Left Ventricular Function
   • Coronary angiography based on cardiology evaluation

1. Medications (“MANCHOMS”)
   • Morphine
   • Aspirin
   • Nitroglycerin
   • Clopidogrogrel if PCI is planned unless contraindicated
   • Heparin iv wt-based, then iv infusion, monitor APTT
   • Supplemental O2 to keep saturation above 92%
   • Metoprolol (HD stable)
   • Statin i.e. Atorvastatin
2. Allergies
3. Labs
   • Troponin, CBC, CMP, Lipid panel now
   • Troponin q3-6 hours
   • Copeptin elevated (new)
4. Consults
   • Cardiology
   • PT
5. Special
   • Pt + Fm education about ACS, meds, lifestyle mod and F/U
   • Smoking cessation resources
   • Other resources

Treatment groups: presumed MI, hemodynamically (HD) stable, HD unstable

1. Presumed MI: MONA
2. HD unstable: stat PCI or CABG, med protocol
3. HD stable:
   • PCI w/in 90m, med protocol
   • NO PCI available > thrombolysis w/in 12h, med protocol
   • >12hr since symptoms: patients still benefit from PCI revascularization

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