ValleyProtocolBook

The Valley Hospital Mobile ICU

16

Standing Orders / Communications Failure Orders

8:41-7.11 Standing orders for acute myocardial infarction/chest pain

(a) The following standing orders are authorized in the event that an adult patient presents with acute myocardial infarction/chest pain:

a. Assess and secure airway;

b. Administer oxygen therapy as patient condition indicates;

c. Administer Acetylsalicylic Acid by mouth to make the total dose received by the patient to a maximum dose of 324mg; this includes any aspirin already taken by the patient prior to ALS encounter;

d. Obtain 12-lead electrocardiogram tracing;

e. Administer 0.4mg Nitroglycerin sublingually every five minutes, provided the systolic blood pressure is greater than or equal to 100 mmHg;

f. Establish vascular access;

g. If the patient is having an acute myocardial infarction, review patient’s eligibility for thrombolytic therapy as determined by the provider’s Medical Director, and follow the New Jersey Department of Health and Senior Services’ STEMI Triage Guidelines;

h. Contact medical command.

(b) The sequence of actions 2 to 6 above may be performed simultaneously and does not need to be in specific order.

Communications Failure Orders for acute myocardial infarction/chest pain

(a) If the patient’s 12-lead electrocardiogram shows a ST Elevation Myocardial Infarction (STEMI), perform the following steps:

1. Transmit all relevant electrocardiograms to the receiving facility.

2. Establish secondary IV/IO access if possible.

3. If the patient is hypotensive with SBP<100 and there is no evidence for congestive heart failure, administer a normal saline boluses of 500 ml until SBP of 120 or a maximum of 2 liters is given. If the patient is hypotensive with an SBP of <100 do not give Nitroglycerine, Morphine or Fentanyl. 4. If the patient has a HR > 80 beats per minute and a systolic blood pressure > 120 mmHg, and there is no evidence of pulmonary edema/congestive heart failure, administer Metoprolol 5mg IV/IO push.

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