BUMC Basics.pdf - Anesthesia Home

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CARDIOLOGY
CCU IN GENERAL
You are typically called for the following patients:
• Patient in the cath lab having a stent placed 2/2 STEMI:
You can go to the cath lab and watch the cath, or you may not
meet them until recovery or when they get to the CCU. These
patients typically come out with post-cath orders filled out by
the cardiologist or fellow, but you sometimes also fill these out
if you are there early in the process. You are then responsible
for getting the HPI and adding additional orders/meds.
• Patient transferring from OSH 2/2 MI s/p lytics: These
patients will need orders as below for ACS, but no GpIIb/IIIa
inhibitors. You will likely do H&P and initial orders and then talk
with the cardiologist then or in the A.M. (if the patient comes in
the night) whether they need to go to cath.
• Patients in the ER with UA/NSTEMI: See management
below
• Decompensated CHF patients with pulmonary edema in
the ER: Follow CHF order set and treat pulmonary edema as
below in pulmonary edema section.
ACUTE CORONARY SYNDROME
Stable Angina: Chest pain resulting from imbalance of
oxygen supply and demand to cardiac
tissue. Usually happens at the same
frequency, intensity, and duration. Most
common cause is CAD; other causes include
aortic valvular disease, HCM, and coronary
artery spasm. This is due to a stable plaque.
UA/NSTEMI: New onset of severe angina, angina at rest
or with minimal activity, or recent increase in
frequency and or intensity of stable angina. If
patient has positive cardiac markers
(necrosis) without ST elevation, then this is
defined as NSTEMI. This is due to a partially
occluding thrombus.