[StillBelieveRN]

Does your Emergency Room have a Chest Pain protocol? If so what are the orders?

[scrmblr]

ekg in 5min.
start a line draw the blood-order the cardiac panel
nitro sl x3-depends on b/p
asa @ 325mg
ox at 2lt
md to see ekg within 5minutes
morphine is a sticky point-we have a "pain protocol" that includes being able to pull morphine for chest pain without a doc's order. I hesitate to use it-only if the doc is impossibly busy.

[Altra]

Our protocol is the same as scrmblr's above.

If the EKG & monitor look like the pt. will be going to the cath lab, I go ahead & start a 2nd line & get the nitro tubing & pumps for NTG, heparin, cardizem ... whatever we end up doing.

Our protocol to get a pt. to the cath lab is 30 min. from the time the decision is made ... but ... if the cath lab is ready sooner than that, the patient goes up. We do not delay to hang heparin, etc. As long as the rhythm is stable enough that we're comfortable with the trip in the elevator, the patient goes.

[StillBelieveRN]

Originally Posted by scrmblr

ekg in 5min.
start a line draw the blood-order the cardiac panel
nitro sl x3-depends on b/p
asa @ 325mg
ox at 2lt
md to see ekg within 5minutes
morphine is a sticky point-we have a "pain protocol" that includes being able to pull morphine for chest pain without a doc's order. I hesitate to use it-only if the doc is impossibly busy.

Do you place the patient on a monitor?!?!?

[RunnerRN]

Ours is similar to above, but a little different. Ours includes:
Monitor, O2, IVSL w blood draw (if we're really busy I'll send CBC, CMP, coags, and hold the cardiac panel), EKG in 5 min, ASA 324mg chewable if no contraindications or pt hasn't taken already.

Our docs are really particular about the cardiac panel. Their reasoning is the liability...how one troponin doesn't tell you anything if onset of pain is less than 6-8 hours in duration, so they'd be forced to admit and draw serial trops (although, in general, if you come in w c/o CP, 90% of the time you'll be admitted).
Our protocol is also only for pts over 30. We don't include NTG.

[Altra]

Originally Posted by RunnerRN

Our docs are really particular about the cardiac panel. Their reasoning is the liability...how one troponin doesn't tell you anything if onset of pain is less than 6-8 hours in duration, so they'd be forced to admit and draw serial trops (although, in general, if you come in w c/o CP, 90% of the time you'll be admitted).
Our protocol is also only for pts over 30. We don't include NTG.

This is a good point about cardiac enzymes. But we send them because, as you pointed out, 90% of the time the pt. will be admitted unless their CP can really be demonstrated to be related to a respiratory issue, muscular pain, or anxiety. So theoretically if all is well, drawing the first set now will shorten their stay by 4 hours.

On a young person, unless their vitals or EKG look crappy I will usually do the EKG only, until the doc has seen them & decides which way we're going to go with this.

[nuangel1]

i agree with the above .ekg within 10 min monitor vs o2 iv labs drawn and sent including troponin ..dr see's ekg immed.if changes 2 nd iv line .we have cath lab protocol to lab within 30 min and we don't wait to hand anything .when lab is ready we move the pt.

[meandragonbrett]

We get an ekg, o2, monitor, ASA, Beta Blocker, Morphine, Nitro and then go from there.

[tiredfeetED]

Originally Posted by meandragonbrett

We get an ekg, o2, monitor, ASA, Beta Blocker, Morphine, Nitro and then go from there.

pretty much the same except the Betablocker...most docs in our ED would freak if the RN started adminstering a bb on a chest pain due to protocol. We also get a PCXR and IV with cardiac markers.

[TazziRN]

We don't have a written protocol but the docs expect us to:

monitor and O2
get an EKG and CXR
start a line and draw cardiac labs
have nitro ready to give and be prepared for a morphine order

If it truly is an evolving or recent MI, start at least one more line and call the tertiary care facility to get a transfer started for a cardiac cath.