Physician'S Order Sheet - Acute M.i. - Clinical Pathway
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1PHYSICIAN'S ORDER SHEET
ALL ORDERS WILL BE FULFILLED UNLESS CROSSED OUT
AFTER EACH ORDER IS PROPERLY CHECKED, FAX ORDER SHEET
TO PHARMACY WHETHER OR NOT ORDERS INVOLVE MEDICATION.
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ACUTE M.I. - Clinical Pathway: Day 1
Each
PAGE 1 of 1
Pharmacy
Order As
Orders
Transcribed
ADMIT TO (UNIT):
ATTENDING:
CARDIOLOGIST:
TEACHING:
IF YES, TEAM:
SR. RESIDENT:
DIAGNOSIS:
ALLERGIES:
VITAL SIGNS PER UNIT PROTOCOL OR:
CARDIAC MONITORING:
DAILY WEIGHTS:
ACTIVITY:
Day 1: Bedrest - Advance as tolerated
2
Diet: Clear Liquids, advance as tolerated to 2 GM Na, low cholesterol, high fiber or,
Fluid Restriction:
I & O:
Labs:
CPK with MB ISO STAT and CK4, CK8. Start in ER
If not done in ER: CBC, PT/PTT, CCP, CHP1
Day 2:
PT/PTT
Day 3:
PT/PTT
Port CXR, if not done in ER
12 lead EKG STAT if not done in ER. Daily in AM x 3 days. STAT PRN chest pain.
Echocardiogram to evaluate LV function to be read by _____________________
Saline Lock with NS flush 2 ml IV q 12 hour or IVF _________________________
MEDICATION OPTIONS:
tpa Protocol (Acute MI) (See separate order sheet)
Heparin IV Protocol (See separate order sheet) -OR- Heparin ____________ units IV
Bolus and start drip of Heparin _____________ units in _____________ ml NS or D5W
at rate of __________________units / hr.
Heparin 5,000 units SQ q 12 hours
Intake and Output
Nitroglycerin IV. Start at 10 mcg/min and titrate to chest pain free. Call H.O.
for chest pain unrelieved by 100 mcg/min. Hold for systolic BP 90.
Nitropaste __________ inch topically q 6 hours. Hold 12 mn to 6 am.
Enteric Coated ASA 325 mg p.o. daily
Colace 100 mg p.o. q HS
FAXED BY/TIME:
TIME NOTED:
Doctor's Signature ____________________________________,MD Date __________
Nurse's
Military Time > >
Signature / Title__________________________________________ Date __________
USE BALL POINT PEN ONLY - PRESS FIRMLY
PART OF THE MEDICAL RECORD
PAGE 1 of 1
8850035 Rev 05/05
Acute MI Physicians Order_CLINICAL PATHWAYS_MEDICAL AFFAIRS
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