Chest Pain Acute Coronary Syndrome - Revision history

Treloars at 12:28, 16 May 2025

2025-05-16T12:28:36Z

← Older revision		Revision as of 12:28, 16 May 2025
Line 79:		Line 79:
	*Current STEMI receiving facilities:		*Current STEMI receiving facilities:
	**AdventHealth Altamonte		**AdventHealth Altamonte
	**~~South Seminole Community Hospital~~		**Orlando Health Lake Mary
	**HCA Florida Lake Monroe Hospital		**HCA Florida Lake Monroe Hospital
	**AdventHealth Orlando		**AdventHealth Orlando
	**AdventHealth Apopka		**AdventHealth Apopka
	**Orlando Regional Medical Center		**Orlando Regional Medical Center

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

2022-03-29T14:37:34Z

4.01 CHEST PAIN/ACUTE CORONARY SYNDROME

← Older revision		Revision as of 14:37, 29 March 2022
Line 78:		Line 78:
	*Patients with identified STEMI/Cardiac alerts must be transported to a STEMI receiving facility.		*Patients with identified STEMI/Cardiac alerts must be transported to a STEMI receiving facility.
	*Current STEMI receiving facilities:		*Current STEMI receiving facilities:
	**~~Florida Hospital~~ Altamonte		**AdventHealth Altamonte
	**South Seminole Community Hospital		**South Seminole Community Hospital
	**~~Central~~ Florida ~~Regional~~ Hospital		**HCA Florida Lake Monroe Hospital
	**~~Florida Hospital~~ Orlando		**AdventHealth Orlando
			**AdventHealth Apopka
	**Orlando Regional Medical Center		**Orlando Regional Medical Center

Treloars at 14:45, 24 April 2020

2020-04-24T14:45:35Z

← Older revision		Revision as of 14:45, 24 April 2020
Line 43:		Line 43:

	'''TREATMENT:'''		'''TREATMENT:'''
	*Consider [[Morphine_Sulfate\|MORPHINE]], [[Oxygen\|OXYGEN]], [[Nitro_Tablets\|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray\|NITROGLYCERIN SPRAY]] AND [[~~Salicylates~~\|ASPIRIN]] (MONA)		*Consider [[Morphine_Sulfate\|MORPHINE]], [[Oxygen\|OXYGEN]], [[Nitro_Tablets\|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray\|NITROGLYCERIN SPRAY]] AND [[Aspirin\|ASPIRIN]] (MONA)
	* Administer [[Oxygen\|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: [[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”)		* 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”)

Treloars at 14:31, 24 April 2020

2020-04-24T14:31:13Z

← Older revision		Revision as of 14:31, 24 April 2020
Line 43:		Line 43:

	'''TREATMENT:'''		'''TREATMENT:'''
	*Consider [[Morphine_Sulfate\|MORPHINE]], [[~~Medical Gases~~\|OXYGEN]], [[Nitro_Tablets\|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray\|NITROGLYCERIN SPRAY]] AND [[Salicylates\|ASPIRIN]] (MONA)		*Consider [[Morphine_Sulfate\|MORPHINE]], [[Oxygen\|OXYGEN]], [[Nitro_Tablets\|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray\|NITROGLYCERIN SPRAY]] AND [[Salicylates\|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: [[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”)		* 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”)

Treloars at 23:38, 23 April 2020

2020-04-23T23:38:39Z

← Older revision		Revision as of 23:38, 23 April 2020
Line 73:		Line 73:
	'''''Remove transdermal patches to avoid excessive dosing. (Transdermal patches may also cause electrical arcing during defib or cardioversion).'''''		'''''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'''		'''TRANSPORT DESTINATION'''

Treloars at 21:24, 23 April 2020

2020-04-23T21:24:27Z

← Older revision		Revision as of 21:24, 23 April 2020
Line 43:		Line 43:

	'''TREATMENT:'''		'''TREATMENT:'''
	*Consider [[Morphine_Sulfate\|MORPHINE]], [[Medical Gases\|OXYGEN]], [[~~Antianginals~~\|NITROGLYCERIN]] AND [[Salicylates\|ASPIRIN]] (MONA)		*Consider [[Morphine_Sulfate\|MORPHINE]], [[Medical Gases\|OXYGEN]], [[Nitro_Tablets\|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray\|NITROGLYCERIN SPRAY]] AND [[Salicylates\|ASPIRIN]] (MONA)
	* Administer [[Medical Gases\|OXYGEN]], nasal cannula if saO2 > 92%; non-rebreather if saO2 < 92%.		* Administer [[Medical Gases\|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"		{\| class="wikitable"
Line 58:		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 [[Morphine_Sulfate\|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)'''''

Treloars at 20:17, 22 April 2020

2020-04-22T20:17:38Z

← Older revision		Revision as of 20:17, 22 April 2020
Line 60:		Line 60:
	* 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, [[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 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)'''''

Treloars at 20:17, 22 April 2020

2020-04-22T20:17:10Z

← Older revision		Revision as of 20:17, 22 April 2020
Line 43:		Line 43:

	'''TREATMENT:'''		'''TREATMENT:'''
	*Consider [[~~Analgesics~~\|MORPHINE]], [[Medical Gases\|OXYGEN]], [[Antianginals\|NITROGLYCERIN]] AND [[Salicylates\|ASPIRIN]] (MONA)		*Consider [[Morphine_Sulfate\|MORPHINE]], [[Medical Gases\|OXYGEN]], [[Antianginals\|NITROGLYCERIN]] AND [[Salicylates\|ASPIRIN]] (MONA)
	* Administer [[Medical Gases\|OXYGEN]], nasal cannula if saO2 > 92%; non-rebreather if saO2 < 92%.		* Administer [[Medical Gases\|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: [[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”)

Treloars at 20:06, 22 April 2020

2020-04-22T20:06:04Z

← Older revision		Revision as of 20:06, 22 April 2020
Line 69:		Line 69:
	* If patient has vomiting or severe nausea, obtain detailed history and administer an Antiemetic medication as appropriate.		* 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 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).'''''		'''''Remove transdermal patches to avoid excessive dosing. (Transdermal patches may also cause electrical arcing during defib or cardioversion).'''''

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

2018-11-27T15:44:57Z

4.01 CHEST PAIN/ACUTE CORONARY SYNDROME

← Older revision		Revision as of 15:44, 27 November 2018
Line 82:		Line 82:
	**Central Florida Regional Hospital		**Central Florida Regional Hospital
	**Florida Hospital Orlando		**Florida Hospital Orlando
	**Florida Hospital East
	**Orlando Regional Medical Center		**Orlando Regional Medical Center

← Older revision		Revision as of 21:24, 23 April 2020
Line 43:		Line 43:

	'''TREATMENT:'''		'''TREATMENT:'''
	*Consider [[Morphine_Sulfate\|MORPHINE]], [[Medical Gases\|OXYGEN]], [[~~Antianginals~~\|NITROGLYCERIN]] AND [[Salicylates\|ASPIRIN]] (MONA)		*Consider [[Morphine_Sulfate\|MORPHINE]], [[Medical Gases\|OXYGEN]], [[Nitro_Tablets\|NITROGLYCERIN TABLETS]] OR [[Nitro_Spray\|NITROGLYCERIN SPRAY]] AND [[Salicylates\|ASPIRIN]] (MONA)
	* Administer [[Medical Gases\|OXYGEN]], nasal cannula if saO2 > 92%; non-rebreather if saO2 < 92%.		* Administer [[Medical Gases\|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"		{\| class="wikitable"
Line 58:		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 [[Morphine_Sulfate\|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)'''''