Chest pain protocol

  1. I am wondering how your Ed treats chest pain. We get EKG in 15 mins, start IV give IV nitroglycerin, Zofran,Ativan, Dilaudid.5, Asa, and Plavix and chest X-ray and cardiac panel. What are your guys orders like
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  2. 46 Comments

  3. by   inchii
    Almost the same, except we use morphine instead of dilaudid, start with sublingual nitro before IV, and add oxygen to the list.
  4. by   Sassy5d
    What do you guys do about drug seekers in your ER? I noticed most of your posts involve giving most pts dilaudid. My drug seekers would love to know where you work ha
  5. by   Esme12
    We do EKG within 10, heploc, O2, ENCASA (Someplaces I have worked go for chewable ASA), SL nitro x3. Full cardiac profile w troponin, full coag profile. CXR. If unrelieved EKG and start IV nitro with MD approval. Further Rx pending immediate MD eval.
    Last edit by Esme12 on Mar 6, '14
  6. by   psu_213
    Some of our docs like SL NTG, other paste. We only go to IV NTG if trops +, STEMI, etc.

    As for EKG time, our goal is 5 minutes or less. This becomes less obtainable if we are really busy, but generally we are able to meet this goal.

    Almost always morphine and not dilaudid for CP.
  7. by   dsherman
    Drug seeker get toradol but I work in a trauma center and we have press ganey on our ::: so most docs give narcs and feed their habit
    Last edit by dsherman on Mar 2, '14 : Reason: Spelling mistake
  8. by   Racer15
    EKG in ten minutes, line, labs, oxygen, CXR, ASA. No other drugs without a physician's order.
  9. by   ohiobobcat
    EKG in 10 minutes. Saline lock, cardiac labs, including a trop I and trop T, ASA 324 mg chewables, SL nitro, O2 if sats below 92%, repeat EKG in 30 minutes, port CXR. We have standing orders for IV morphine, beta blocker and Plavix, but I usually check with the doc before giving any of those meds.
  10. by   1fastRN
    Door to EKG time under 10 mins.

    MONA (morphine, 02, nitro, ASA)

    Portable CXR, cbc, chem, trop, coags

    Treatment is different and much more aggressive if EKG is positive for MI. Coags, type & screen, heparin initiation, cath lab activation
  11. by   zmansc
    Pretty much the same as 1fastRN, although we don't activate the cath lab, we activate the whirly bird, TNKase or equiv, nitro/heparin drips, and 3 lg bore IVs, hopefully before the flight crew is ready to take them.
  12. by   Altra
    OP, I'm assuming you don't give all of those meds to every patient who presents with chest pain ...
  13. by   emtb2rn
    Quote from Racer15
    EKG in ten minutes, line, labs, oxygen, CXR, ASA. No other drugs without a physician's order.
    We're the same. Most of our docs seem to prefer nitro over morphine as first line in reducing chest pain.
  14. by   Loo17
    EKG, line and labs, cardiac monitor, oxygen, aspirin, nitro SL, morphine, CXR.

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