Emergency Department (ED) Algorithm/Protocol for Patients with S/S of AMI

Onset of
symptoms

Ambulance presents Patient presents

patient to ED lobby to ED lobby

ED triage or charge nurse triages

patient ( non-traumatic)
• AMI signs and symptoms
• 12-lead EKG STAT
• Brief, targeted history

Emergency nurse initiates emergency nursing care Emergency physician

in acute care area of ED ( per-protocol) evaluates patient
• History
• cardiac monitor * Blood studies • Physical exam
• oxygen therapy * Nitroglycerin • Interpret EKG
• IV SL * Aspirin

AMI
patient

Yes No
**consult Evaluate
further

Interventionalist Interventionalist
off campus on campus and Patient to cath
and/or cath lab cath lab available lab ASAP
not available

Other indicated treatment Conduct education

Candidate for
• Other drugs for AMI and F/U instruction
fibrinolytic
(lovenox, ASA,
therapy ?
nitrates)
• Transfer to cath lab
for PTCA or surgery
Fibrinolyti for CABG
c therapy:
Retavase admit Release
or TNK

** Call & page Interventionalist. If no response in 15 min

or off campus. Give fibrinolytic. DOLR 2-8-07