• VITALS
• OXYGEN SATURATION
• IV
• EKG
• TARGETED BY H & P
• ELIGIBILITY FOR THROMBOLYTICS

SOON ASSESSMENT

• Chest X-ray
• Blood studies (lytes, enzymes, coags)
• Consult as needed

TREATMENTS
(not all may be appropriate)

• OXYGEN AT 4 L/min
• NITROGLYCERIN SL, PASTE OR SPRAY
• MORPHINE IV
• ASPIRIN PO
• THROMBOLYTIC AGENTS
• Nitroglycerine IV
• ß-blockers IV
• Heparin IV
• Lidocaine IV (prophylactic lidocain NOT recommended for all patients
• Magnesium Sulfate IV
• Angioplasty

THROMBOLYTIC CONTRAINDICATIONS
(others may apply)

• Prolonged or traumatic CPR
• Trauma or surgery in last 2 months
• Active internal bleeding
• Recent GI or GU bleed
• Bleeding disorder or warfarin use
• Diabetic hemorrhagic retinopathy
• Suspected aortic dissection
• History of BP > 180/110
• Head trauma or neoplasm
• Pregnant state
• Liver or kidney dysfunction

Time in ER to thrombolytic therapy: 30-60 minutes