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Review &/or modify guideline to meet patient’s individual plan of care daily & prn. If an
expected treatment is not performed, indicate modification on the attached Guideline
Modification Record
Affix Label here
Care Guideline
Date Initiated:
Initiated By:
Acute Myocardial Infarction
(Nurse)
(Page 1 of 4)
This is a base standard of care for Acute Myocardial Infarction, please refer to corresponding Guideline Physician’s Orders.
This Guideline should be modified to meet individual patient needs, and is not intended to replace individual patient care plan.
Category
Step 1 - Admission CCU
Lab Tests
If
1.
2.
If
3.
Diagnostic
Procedures



2D
Step 2 –
Step 3 – Transfer
Step 4 – Discharge
(24-36 hour target)
(48-72 hour target)
(86+ hour target)
<24 hours from onset of pain
Cardiac profile with coag on admission
CKMB @ 8-16-24 hrs
> 24 hours from onset of pain
Troponin cardiac profile with coag on
admission

Fasting cholesterol fractionation in am
ECG
ECG prn for chest pain
CXR (portable on admission)
echocardiogram (as indicated)
Consults
Cardiology:
Interventions/
Treatments



Outpatient lab
(as necessary)

ECG
ECG
Consider outpt lowlevel treadmill test or
cardiac catheterization
(as indicated)
Cardiac monitor
Oxygen pathway: 3L/min on admission x3
hours & prn chest pain, may discontinue if
SaO2 >92% and pain free
Consider IV thrombolytic therapy (30 min
door-drug for eligible pts)
Consider cath/PTCR as alternative to
thrombolysis (90 min door-inflation)
Consider cath/PTCR for persistent pain,
ischemia or failed thrombolysis

Page 1 of 5
Telemetry monitoring


Discontinue telemetry
outpt cardiac rehab
referral
Care Guideline
Affix Label here
Acute Myocardial Infarction
(Page 2 of 4)
This is a base standard of care for Acute Myocardial Infarction, please refer to corresponding Guideline Physician’s Orders.
This Guideline should be modified to meet individual patient needs, and is not intended to replace individual patient care plan.
Category
Medications
Step 1 - Admission CCU












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
Aspirin
Saline lock with flush
IV heparin initial bolus & infusion, then wt
based protocol
Lovenox (low molecular wt Heparin)
Beta-blockers (Contraindications include
•



Step 2 –
Step 3 – Transfer
(24-36 hour target)
(48-72 hour target)
Statin
Discontinue IV
nitrates
Discontinue
continuous IV
Antiarrhythmics
cardiogenic shock or hypotension, bradycardia with
HR less than 50, advanced AV block, active asthma,
severe reactive airway disease)
ACE inhibitors: ______________________
Nitrates: ___________________________
IV morphine sulfate pm
Antiarrhythmics
Stool softener
Analgesics (mild)
ACLS emergency drugs per protocol
Antacids
Sleep aid
Page 2 of 5
•
•
•
Convert IV to saline
lock
Discontinue IV
heparin
Discontinue IV
morphine
Step 4 – Discharge
(86+ hour target)
•
Discontinue saline
lock
Home Medications
(if indicated)
•
•
•

Aspirin
Beta blocker
ACE inhibitor
Statin
Patient Care
Intervention



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
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
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
I&O (critical care unit)
VS per unit routine
Monitor patient response to initial reperfusion
strategy (primary PTCA)
Assess for any bleeding q 2 hrs x4, then q 4
hrs x 24 with GP IIb/IIIa antagonist
Physical assessment & reassessment per unit
standard
ST Segment monitoring
Assess patient response to any antianginal
therapy
Evaluate cardiac rhythm q 8 hrs & prn
Physician notification (primary & cardiologist)
symptomatic HR <60 or
>110, SBP <90 or >150, resp rate <8 or >22,
recurrence of chest pain unrelieved with nitro
Transfer to ___________
• VS per unit routine
• D/C I&O
Care Guideline
Affix Label here
Acute Myocardial Infarction
(Page 3 of 4)
This is a base standard of care for Acute Myocardial Infarction, please refer to corresponding Guideline Physician’s Orders.
This Guideline should be modified to meet individual patient needs, and is not intended to replace individual patient care plan.
Category
Step 1 – Admission CCU
Activity


BSC, chair, OOB-if pain free/hemodynamically stable
ADLs with assistance
Nutrition


Clear liquids advance as tolerated to cardiac diet
Dietary evaluation
Psychosocial/
Pastoral Care


Encourage patient/SO to discuss anxieties
Explore successful coping mechanism
Step 2 –
Step 3 – Transfer
Step 4 – Discharge
(24-36 hour target)
(48-72 hour target)
(86+ hour target)

•
Ambulate as tolerated
Bathroom privileges
•
Reassure pt/SO
regarding pt’s
progress
Page 3 of 5

Review available
resources and
support systems


Shower
Ambulation ad lib

Discuss any concerns
related to discharge
and lifestyle changes
Education

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

Initiate teaching of basic disease
pathophysiology to patient/SO
Explain rationale for treatment plan (e.g.,
bedrest and frequent labs), thrombolytic
/primary PTCA teaching if indicated
Provide written AMI material
Instruct patient to verbalize any chest pain or
associated symptoms
Emphasize need for rest
Evaluate current smoking/tobacco use and
need for cessation education/intervention
Provide smoking cessation counseling/ advice
for pts who have smoked during the previous
year. Provide reinforcement for those who
have never smoked or have quit.
Case
Management

Case Manager interviews patient/SO and
begins coordinating discharge plan/services
Outcomes

Patient will be pain-free within 30 minutes of
arrival to ED
Eligible patient will receive thrombolytics
within 30 minutes or PTCA within 90 minutes,
then transferred to CCU
Patient will remain hemodynamically stable
Patient will explain importance of notifying RN
of any chest pain
Patient will be able to explain thrombolytics or
catheterization/PTCA if needed
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
Affix Label here

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



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Reinforce
pathophysiology and
treatment teaching
Discuss AMI and
identify risk factors
Provide initial
teaching for new
meds (i.e., betablockers, aspirin, ACE
inhibitors, statins)
Pt will remain painfree/hemodynamically
stable
Lab values will begin
to normalize
ECG will be evolving
with ST segment
returning to baseline
Pt/SO will be able to
describe basic
pathophysiology of
AMI

Reinforce teaching on
risk factor
modification;
continue medication
teaching
Initiate risk factor
modification


Reinforce discharge
plan

Complete discharge
plan

Pt will be pain-free,
up, and out of bed
Pt will be progressing
with activity

Patient/SO will be able
to explain medication
rationale/side effects
Patient/SO will be able
to describe risk factor
modification techniques
Patient/SO will be able
to explain home meds
schedule, discharge
instructions for home,
diet instruction, and
activity guidelines






Reinforce all
discharge teaching
Reinforce home
medication schedule
Provide postprocedure education
materials
Care Guidelines are to be reviewed and modified once each day and prn, to meet the
patient’s individual plan of care. Modifications to Guideline Expected Care Criteria are
to be documented on this Guideline Modification Record.
Guideline/Review Modification Record
Acute Myocardial Infarction
(Page 4 of 4)
Date Guideline
Reviewed/Modified
Signature
Date Guideline
Reviewed/Modified
Page 4 of 5
Signature
Date
Category
Modification - Signature
MO-03-05-AMI March 2003
This material was prepared by Primaris under contract
with the Centers for Medicare & Medicaid Services (CMS).
The contents presented do not necessarily reflect CMS policy.
Page 5 of 5