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STEMI

  • Admission orders

    • Admit to: CCU, telemetry
    • Diagnosis: STEMI
    • Condition: Guarded
    • Vital Signs: Unit routine
    • Allergies:
    • Nursing: O2 2L, increase as necessary to maintain oxygen saturation > 93%, Guaiac all stools, Check blood glucose before each meal and at bedtime
    • Diet: Heart Healthy Diet, NPO 6h before cath
    • Activity: Bedrest
    • Labs:
      • EKG on admit, and for recurrent chest pain
      • enzymes: CK-MB, troponin, cycle q8 x 3
      • CBC qd
      • Chem, magnesium qd
      • Coags: PT, PTT
      • Lipid panel: cholesterol, HDL, LDL
    • IV Fluids: NS
    • Special:
      • nutritionist
      • smoking cessation
      • social work
    • Medications:
      • Aspirin 325 mg PO qd, first now if not already given
      • Clopidogrel 75 mg PO qd
      • Metoprolol 50 mg PO q 12 h. Hold for SBP < 100 mmHg, HR < 50 bpm, and call MD
      • Eptifibatide 2 mg/kg/min for 18 hours post-stent placement
      • Enalapril 2.5 mg PO q 12 h. Hold for SBP < 100 mmHg
      • Nitroglycerin 0.4 mg sublingual (SL) prn chest pain; may repeat in 5 minutes
      • Morphine sulfate 1-4 mg IV every 5 minutes prn chest pain, not to exceed 10 mg in 1 hour. Hold for sedation, RR < 10 breaths/min, or SBP < 90 mmHg
  • Discharge

    • education: nutrition, smoking, activity level, return to work, meds
    • meds
      • A beta blocker
      • Aspirin
      • An ACEI if left ventricular (LV) dysfunction, anterior MI, or inadequate BP control on beta blocker
      • A statin
      • Clopidogrel
    • f/u 2 weeks

  • Print | Citations

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