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General Orders


* EKG stat; * Control of CP: 
- NTG: 0.3mg SL q5' x 2 / NTG: 0.6mg SL x 1 
- Morphine 2-4mg alliquots; repeat in 5 min prn; 
- Will Decrease Pain & CO / Naloxone prn Resp Depress; 
- Atropine 0.4 mg IV prn Bradycardia; but avoid if possible; 
- Dramamine prn N/V; 
- B Blockers may also be used to decrease pain & CO * IV lidocaine for PVCs 
- prophylactic lidocaine should be given to all patients with definite acute myocardial infarction, even if ventricular ectopy is not present; * D5W IV TKVO * ABG: if needed; * Cardiac Enz * Consider Heparin Therapy/Thrombolytic therapy; * Aspirin PO qd; * Consider d/c'ing Diuretics w/ Acute CHF; * Post Infarction Angina: pts should be stabilized w/ Nitrates & diltiazem 
- Refractory patients: Continous NTG and/or B blockers * Non Q wave Infarction: add diltiazem 240-360 mg qd; * Accelerated Idioventricular Rhythm: 60-100 BPM: Consider Atropine occurs in the setting of Bradycard * A. fib: usually transient in MI setting; may require B blocker * Heart rate should remain at the lowest rate possible;
- avoid Atropine unless absolutely necessary: * See Discussion of Beta Blockers for MI * Use of Ca Channel Blockers in MI patient: * Note: Dobutamine and moderate volume loading are the treatment of choice in patients with hemodynamically significant right ventricular infarction