Acute ST Elevation MI/Potential PCI Pathway Stephens Memorial Hospital Emergency Services Action Taken
Time of ES arrival: Pain on arrival /10 Time of chest pain onset _______ Pain at onset /10 ___ CP greater than 12 hr Y N Hx: STAT EKG: given to physician @: ______ ST Elevation Y N New LBBB Y N Subsequent EKG Times: ____________ ST Elevation Y N Subsequent EKG Times: ____________ ST Elevation Y N Subsequent EKG Times: ____________ ST Elevation Y N Page "Code Purple" O2 _______ Liters by N/C Mask
Rescue stand-by PACE called to ES @ ____ PACE Arrival @ __________ Cardiac Monitor Rhythm IV _____ga _____Site SL N/S @ _____ mL/hr
Order ICU Labs Stat Portable Chest xray stat
325 mg ASA po ordered not ordered contraindicated
allergic unable to swallow Given/taken prehospital
Second IV ____ ga ____ Site SL N/S @ ____ mL/hr Viagra/Livitra/Cialis within 24 hours? Y N # 1 Nitro SL 1/150, 1 Q 5 minutes prn chest pain # 2 Nitro SL 1/150, 1 Q 5 minutes prn chest pain # 3 Nitro SL 1/150, 1 Q 5 minutes prn chest pain Morphine Sulfate 2-4 mg IV push for pain Dose given ______ mg Fentanyl 25-50 Mcg IV push for painDose given ______ mg Stated Ht _______ cms Stated Wt ______ kg Heparin bolus IV: 60 units x ___ kg=_______units Max=4000 Units Call to MMC One-Call 1-207-662-2950 Lytic Contraindicated _____ Primary PCI go to page 2
Physician Signature: ____________________RN Signature: _______________
Acute ST Elevation MI/Potential PCI Pathway Stephens Memorial Hospital Emergency Services Action Taken TNKase according to protocol if ordered. From one vial of TNKase reconstitute with 10 mL diluent: Final Concentration = 5 mg/mL. To prevent precipitation administer over 5 seconds into running NS IV Patient Weight (kg) TNKase (mg) Volume TNKase to be Administered (mL) Lytic & PCI Lytic & Observation Heparin premix (25000 units/500 mL D5W) infusion: Start at 1000 units/hour (20 mL/min) or as ordered ____________________ (may hold/dc for pts being transferred) IV nitroglycerin drip on physician order; titrate to Systolic B/P greater than 100 (consider nitro paste if IV drip likely to delay transport) Plavix 300 mg PO Stat ordered not ordered Benadryl 50 mg po now ordered not ordered # 1 Metoprolol 5 mg IV push Q 5 mins Reason Withheld: # 2 Metoprolol 5 mg IV push Reason Withheld: # 3 Metoprolol 5 mg IV push Reason Withheld: Call MMC for Nurse to Nurse report 1-207-662-3838 (let it ring) Report given to _____________________ by __________________ EMTALA form completed Fax demographic face sheet to MMC 1-207-662-3682 Pt/family information sheet given Family not present Directions to Maine Medical given Directions to ____________ Hospital given Voided before transport ______ mL Has not voided
If time, prepare pt for cardiac cath lab: Remove clothing Plastic snap johnnie Transport O2 and monitor Bag personal belongings and label valuables envelope sent with pt given to family If transferred before lab results, FAX results to (207)662-6385 COPY both pages of this form and send COPY with patient in red rapid transport folder Disposition: Admit to ICU Transfer to:_________________ Time of Departure from ES
Physician Signature: ____________________RN Signature: _______________
Acute Gastroenteritis (Diarrheal illness) in Guyana The Ministry of Health has received an unusual number of calls from the public relating to diarrheal illnesses. In addition, the media has also become very interested in the public health problem. The Ministry of Health believes if people are kept informed, they will be able to take necessary action to reduce the problem. It is a public hea
Molecular Pathology of these pathways could be used clinically, we conducted a randomized phase II trial based on letrozole (LET arm) with or Laboratory without ‘metronomic’ oral cyclophosphamide. PI3K, AKT, and mTOR were assessed on tumour specimens collected before and after treatment in patients randomized in this trial. The primary aim was to explore the changes of these molecu