Chest Pain Acute Coronary Syndrome - Revision history

Mfrdmanager at 13:37, 13 November 2020

2020-11-13T13:37:27Z

Mfrdmanager at 13:30, 13 November 2020

2020-11-13T13:30:29Z

Mfrdmanager at 13:26, 13 November 2020

2020-11-13T13:26:55Z

Mfrdmanager: /* 4.01 CHEST PAIN/ACUTE CORONARY SYNDROME */

2018-12-31T15:24:47Z

‎4.01 CHEST PAIN/ACUTE CORONARY SYNDROME

Mfrdmanager: /* 4.01 CHEST PAIN/ACUTE CORONARY SYNDROME */

2018-12-31T15:24:11Z

‎4.01 CHEST PAIN/ACUTE CORONARY SYNDROME

Mfrdmanager: /* 4.01 CHEST PAIN/ACUTE CORONARY SYNDROME */

2018-12-31T15:23:06Z

‎4.01 CHEST PAIN/ACUTE CORONARY SYNDROME

Mfrdmanager at 21:19, 21 March 2018

2018-03-21T21:19:41Z

Mfrdmanager: Protected "Chest Pain Acute Coronary Syndrome" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

2018-02-10T13:58:52Z

Protected "Chest Pain Acute Coronary Syndrome" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

Mfrdmanager: Created page with "== Section 5 - MEDICAL == === 5.01 ACUTE ABDOMINAL PAIN === '''''CONSIDER CARDIAC ETIOLOGY.''''' INITIAL MEDICAL CARE (2.01) - Provid..."

2018-02-10T13:58:44Z

Created page with "== Section 5 - MEDICAL == === 5.01 ACUTE ABDOMINAL PAIN === '''''CONSIDER CARDIAC ETIOLOGY.''''' INITIAL MEDICAL CARE (2.01) - Provid..."

New page

== Section 5 - MEDICAL ==
=== 5.01 ACUTE ABDOMINAL PAIN ===

'''''CONSIDER CARDIAC ETIOLOGY.'''''

[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - Provide OXYGEN or assist ventilations as appropriate for patient condition. Use vomiting precautions.
* If hypotension / shock is present, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
* For patients with severe vomiting, obtain detailed history, and then administer an appropriate antiemetic.
** [[Antiemetics|ZOFRAN (ONDANSETRON HYDROCHLORIDE)]]:
*** Adult: 4mg slow IVP or 1 ODT tab.
****When administering IV, consider diluting in 10-20cc to aid in administering slowly or 4mg/2ml deep IM in a large muscle.
*** Pediatric: Refer to Handtevy System
***'''NOTE''': Use PO administration route for conscious patients '''ONLY'''.
** [[Antiemetics|PHENERGAN (PROMETHAZINE)]]:
*** Adult (>13 y/o): 12.5 MG DILUTED and slow IVP or IM.
*** Pediatric: 0.25 - 1 mg/kg DILUTED and slow IVP or IM.
{| class="wikitable"
|-
! The administration of [[Antiemetics|PHENERGAN (PROMETHAZINE)]] in pediatric patients should only be considered if there is persistant vomiting and [[Antiemetics|ZOFRAN (ONDANSETRON HYDROCHLORIDE)]] is not effective.
|}
{| class="wikitable"
|-
! '''BLACK BOX WARNING'''
The IV (perenteral) administration of [[Antiemetics|PHENERGAN (PROMETHAZINE)]] has a '''RELATIVE CONTRAINDICATION''' in children under 2 years of age. The provider must weigh the risk vs. benefit of [[Antiemetics|PHENERGAN (PROMETHAZINE)]] administration based on the patient's condition.
|}
* If suspected Kidney Stones, refer to [[Suspected Kidney Stone|SUSPECTED KIDNEY STONE]] parameter (5.18)
* Refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PRACTICE PARAMETERS]] (2.04)
* Administer nothing by mouth.

[[Category:Medical|0501]]

@@ Line 84: / Line 84: @@
 **Orlando Regional Medical Center
-[[File:Chest_Pain_Flowchart_2013-06.pdf]]
+[[File:Chest Pain Flowchart 2020-10-22.pdf]]
 [[Category:Cardiac|0401]]

@@ Line 84: / Line 84: @@
 **Orlando Regional Medical Center
-[[File:Chest_Pain_Flowchart_2013-06.jpg]]
+[[File:Chest_Pain_Flowchart_2013-06.pdf]]
 [[Category:Cardiac|0401]]

@@ Line 30: / Line 30: @@
 * ST elevation > 1.0 mm present in two (2) or more inferior leads
 * ST elevation > 2.0 mm in two (2) or more precordial leads
 '''When transporting a STEMI to the ED of any hospital, have your EKG strip initialed by the attending physician verifying the STEMI or not. Please ask the physician to initial, date and to indicate “Yes” or “No” to certify the correct diagnosis of STEMI or not. If you are unable to have the physician initial at the time of your transport you may have him do it the next time you are at the ED.'''
@@ Line 45: / Line 43: @@
 '''TREATMENT:'''
-*Consider [[Analgesics|MORPHINE]], [[Medical Gases|OXYGEN]], [[Antianginals|NITROGLYCERIN]] AND [[Salicylates|ASPIRIN]] (MONA)
+*Consider [[Morphine_Sulfate|MORPHINE]], [[Oxygen|OXYGEN]], [[Nitro_Tablets|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray|NITROGLYCERIN SPRAY]] AND [[Aspirin|ASPIRIN]] (MONA)
-* Administer [[Medical Gases|OXYGEN]], nasal cannula if saO2 > 92%; non-rebreather if saO2 < 92%.
+* Administer [[Oxygen|OXYGEN]], nasal cannula if saO2 > 92%; non-rebreather if saO2 < 92%.
-* If systolic BP > 110 mm Hg: [[Antianginals|NITROGLYCERIN]] 0.4 mg SL (Do not withhold if unable to establish IV). Repeat at 5 minute intervals until either systolic BP < 110 mm Hg or [[Antianginals|NITROGLYCERIN]] drip established. (Team member should be assigned as “nitro-time keeper”)
+* If systolic BP > 110 mm Hg: [[Nitro_Spray|NITROGLYCERIN SPRAY]] or [[Nitro_Tablets|NITROGLYCERIN TABLETS]] 0.4 mg SL (Do not withhold if unable to establish IV). Repeat at 5 minute intervals until either systolic BP < 110 mm Hg or [[Nitro_Drip|NITROGLYCERIN]] drip established. (Team member should be assigned as “nitro-time keeper”)
 {| class="wikitable"
@@ Line 60: / Line 58: @@
-* If systolic BP > 110 mm Hg, [[Antianginals|NITROGLYCERIN DRIP]], START at 5-15 mcg/minute via Infusion Regulator (Dial-a-Flow device) or Buretrol device. Titrate and increase [[Antianginals|NITROGLYCERIN DRIP]] at 5 mcg/minute increments every 3-5 minutes until relief of discomfort. Establish second IV of NaCl, however keep in mind the patient may be a candidate for Thrombolytics. Monitor and document BP every 5 minutes. If pain is relieved, leave drip at setting when relief occurred.
+* If systolic BP > 110 mm Hg, [[Nitro_Drip|NITROGLYCERIN DRIP]], START at 5-15 mcg/minute via Infusion Regulator (Dial-a-Flow device) or Buretrol device. Titrate and increase [[Nitro_Drip|NITROGLYCERIN DRIP]] at 5 mcg/minute increments every 3-5 minutes until relief of discomfort. Establish second IV of NaCl, however keep in mind the patient may be a candidate for Thrombolytics. Monitor and document BP every 5 minutes. If pain is relieved, leave drip at setting when relief occurred.
-'''''If pain is not relieved and/ or more severe- follow initial nitro drip infusion with [[Analgesics|MORPHINE SULFATE]] administration Refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PARAMETERS]] (2.04)'''''
+'''''If pain is not relieved and/ or more severe- follow initial nitro drip infusion with [[Morphine_Sulfate|MORPHINE SULFATE]] administration Refer to [[Analgesia and Sedation|ANALGESIA/SEDATION PARAMETERS]] (2.04)'''''
@@ Line 71: / Line 69: @@
 * If patient has vomiting or severe nausea, obtain detailed history and administer an Antiemetic medication as appropriate.
 * If systolic BP < 90 mm Hg, consider fluid boluses in increments of 200 - 300 ml, to titrate systolic BP > 90 mm Hg. Monitor for signs of fluid overload.
-* If condition worsens despite fluid therapy, administer [[Adrenergics|DOPAMINE]] 5 - 20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.
+* If condition worsens despite fluid therapy, administer [[Dopamine|DOPAMINE]] 5 - 20 mcg/kg/minute titrated to systolic BP > 90 mm Hg.
 '''''Remove transdermal patches to avoid excessive dosing. (Transdermal patches may also cause electrical arcing during defib or cardioversion).'''''
-'''''Vasovagal reaction may occur. It is usually transient and responds to elevating the patient’s legs. [[Antiarrhythmics|ATROPINE]] may be used but is rarely necessary.'''''
+'''''Vasovagal reaction may occur. It is usually transient and responds to elevating the patient’s legs. [[Atropine|ATROPINE]] may be used but is rarely necessary.'''''
 '''TRANSPORT DESTINATION'''

@@ Line 30: / Line 30: @@
 * ST elevation > 1.0 mm present in two (2) or more inferior leads
 * ST elevation > 2.0 mm in two (2) or more precordial leads
-'''When a STEMI has been diagnosed and the transport destination is a Florida Hospital facility, crews will contact FH Transfer Center and initiate a STEMI Alert (407) 303-1610. Crews will provide destination and Pt's cardiolist information.'''<sp>
+'''When a STEMI has been diagnosed and the transport destination is a Florida Hospital facility, crews will contact FH Transfer Center and initiate a STEMI Alert (407) 303-1610. Crews will provide destination and Pt's cardiolist information.'''
 '''When transporting a STEMI to the ED of any hospital, have your EKG strip initialed by the attending physician verifying the STEMI or not. Please ask the physician to initial, date and to indicate “Yes” or “No” to certify the correct diagnosis of STEMI or not. If you are unable to have the physician initial at the time of your transport you may have him do it the next time you are at the ED.'''

@@ Line 30: / Line 30: @@
 * ST elevation > 1.0 mm present in two (2) or more inferior leads
 * ST elevation > 2.0 mm in two (2) or more precordial leads
-'''When a STEMI has been diagnosed and the transport destination is a Florida Hospital facility, crews will contact FH Transfer Center and initiate a STEMI Alert (407) 303-1610. Crews will provide destination and Pt's cardiolist information.'''
+'''When a STEMI has been diagnosed and the transport destination is a Florida Hospital facility, crews will contact FH Transfer Center and initiate a STEMI Alert (407) 303-1610. Crews will provide destination and Pt's cardiolist information.'''<sp>
 '''When transporting a STEMI to the ED of any hospital, have your EKG strip initialed by the attending physician verifying the STEMI or not. Please ask the physician to initial, date and to indicate “Yes” or “No” to certify the correct diagnosis of STEMI or not. If you are unable to have the physician initial at the time of your transport you may have him do it the next time you are at the ED.'''

@@ Line 1: / Line 1: @@
-== Section 5 - MEDICAL ==
+==Section 4 - CARDIAC==
-=== 5.01 ACUTE ABDOMINAL PAIN ===
+===4.01 CHEST PAIN/ACUTE CORONARY SYNDROME===
-[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - Provide OXYGEN or assist ventilations as appropriate for patient condition. Use vomiting precautions.
+'''Perform initial assessment:'''
-* If hypotension / shock is present, refer to [[Shock|SHOCK PRACTICE PARAMETER]] (5.13).
+* Interview and subjective assessment
-* For patients with severe vomiting, obtain detailed history, and then administer an appropriate antiemetic.
+* Vital signs
-** [[Antiemetics|ZOFRAN (ONDANSETRON HYDROCHLORIDE)]]:
+* Oxygen saturation and sideline/sidestream capnography if available
-*** Adult: 4mg slow IVP or 1 ODT tab.
+* Pre-treatment 12-Lead ECG
-****When administering IV, consider diluting in 10-20cc to aid in administering slowly or 4mg/2ml deep IM in a large muscle.
+* Focused history (SAMPLE, OPQRST)
-*** Pediatric: Refer to Handtevy System
+* Identify '''cardiac risk factors and contraindications''' for Fibrynolytics
-***'''NOTE''': Use PO administration route for conscious patients '''ONLY'''.
+* Physical exam
-** [[Antiemetics|PHENERGAN (PROMETHAZINE)]]:
+* Inquire if the patient has an old ECG and Cardiologist name
-*** Adult (>13 y/o): 12.5 MG DILUTED and slow IVP or IM.
-*** Pediatric: 0.25 - 1 mg/kg DILUTED and slow IVP or IM.
 {| class="wikitable"
 |-
-! The administration of [[Antiemetics|PHENERGAN (PROMETHAZINE)]] in pediatric patients should only be considered if there is persistant vomiting and [[Antiemetics|ZOFRAN (ONDANSETRON HYDROCHLORIDE)]] is not effective.
+! Black Box Warning
 |-
-! '''BLACK BOX WARNING'''
+| '''''The administration of sublingual nitroglycerin is CONTRAINDICATED if the patient taking daily doses of or has a recent history (36-48 hrs) of using any type of erectile dysfunction medications from the phosphodiesterase type 5 (PDE-5) class such as Sildenafil Citrate (Viagra), Vardenafil (Levitra) or Tadalafil (Cialis).'''''
-The IV (perenteral) administration of [[Antiemetics|PHENERGAN (PROMETHAZINE)]] has a '''RELATIVE CONTRAINDICATION''' in children under 2 years of age.  The provider must weigh the risk vs. benefit of [[Antiemetics|PHENERGAN (PROMETHAZINE)]] administration based on the patient's condition.
 |}
-[[Category:Medical|0501]]

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