CL Item
Medical Floor (3)
CL Item
Monitored Bed (4)
Status: Specification of Other
Item
If Other, please specify
text
Attending
Item
Name of attending physician
text
Phone number
Item
Phone number of attending physician
integer
Admitting Diagnosis
Item
Acute MI Contributing Diagnosis
text
Nursing
Item
Vital signs: per routine
boolean
Nursing
Item
O2 @ 2,4,6 L/min via nasal cannula
boolean
Nursing
Item
12 lead ECG: stat (if not done in ER) and every morning
boolean
Nursing
Item
Portable CXR if not done in ER
boolean
Nursing
Item
Continuous cardiac monitoring
boolean
Nursing
Item
Arrythmia protocol
boolean
Nursing
Item
2D Echo with Doppler flow
boolean
Nursing: 2D Echo
Item
If 2D Echo, please specify to be read by
text
Medications
Item
Clopidogrel 300mg PO now, then 75 mg PO daily
boolean
Medications
Item
ASA 81 mg, 4 PO now (if not given in ER)
boolean
Medications
Item
ECASA 325 mg PO daily
boolean
Medications
Item
Lovenox __ mg (1mg/kg) severy every 12 hrs-start now
boolean
Medications
Item
Nitropaste __ in (es) every __hrs
boolean
Medications
Item
Zocor __ mg PO with evening meal
boolean
Medications
Item
NTG 0.4 mg SL every 5 min prn chest pain X3 doses
boolean
Medications
Item
Beta blocker: Metoprolol 12.5 mg PO now and then __ mg every 12 hrs
boolean
Medications
Item
ACE: Captopril 6.25 mg PO now and then 12.5 mg PO in every 8 hrs (hold for SBP < 105 or patient going to cath lab)
boolean
Metoprolol specification
Item
If Beta Blocker, please specify amount
integer
Zocor specification
Item
If Zocor, please specify amount
integer
Levonox Specification
Item
If Lovenox, please specify amount
integer
Nitropaste specification
Item
If Nitropaste, please specify amount
integer
Lab
Item
Hemogram
boolean
Lab
Item
Fasting lipid panel
boolean
Lab
Item
Troponin I
boolean
Lab
Item
Comp med profile; if not done in ER
boolean
Lab
Item
Repeat CK, CK-MB, Troponin I @__ (8hrs) and __ (16 hrs)
boolean
Specification of Repetition at 8 hrs
Item
If Repetition of CK, CK-MB and Troponin I, please specify amount after 8 hrs
integer
Specification of Repetition at 16 hrs
Item
If Repetition of CK, CK-MB and Troponin I, please specify amount after 16 hrs
integer
Consider
Item
NTG drip(50 mg in 250 mL D5W); start at 3 mcg/min and titrate to relieve chest pain and maintain SBP < 130 and > 90
boolean
Consider
Item
Integrilin 180 mcg/kg IV bolus (__ mcg total) over 1-2 min then IV infusion @ 2 mcg/kg/min, not to exceed 72 hrs; while on infusion, obtain hemogram, creat every 8 hrs- if platelets < 1,000,000 call MD
boolean
Consider
Item
If creatinine level 2-4; decrease by half; if creatinine > 4 discontinue infusion and call MD
boolean
Consider
Item
Tylenol 650 mg every 4-6 hrs prn pain/fever
boolean
Consider
Item
Ambien 5 mg @ bedtime prn insomnia
boolean
Consider
Item
MOM 15-30 mL PO every 12 hrs prn constipation
boolean
Integrilin specification
Item
If Integrilin, please specify amount of total Integrilin
integer
Signature
Item
Signature
text
Print Name
Item
Print Name
text
Date and Time
Item
Date and Time
datetime
