NSTEMI

NSTEMI / UA
[ ] Ask about cocaine, viagra
[ ] ASA 325 PO
[ ] Clopidogrel 600 mg PO
[ ] heparin 60 U/kg bolus (max 4,000 U), then 12 U/kg/h (maximum 1,000 U/h) gtt, titrat to aPTT 50-75
[ ] If h/o HIT, use Bivalrudin instead: 0.25 mg/kg IV bolus, then 0.5 mg/kg/hr gtt for first 12 hours, f/b 0.25 mg/kg per hour next 36 hours
[ ] Nitro and/or Morphine for pain
[ ] Beta blocker can be deferred … but if HTNive, tachy, with CP, or c/f evolving into VF/VT, give Metoprolol 5 mg IV x 1-3 f/b Metoprolol 25 mg PO
[ ] D/c all NSAIDs
[ ] Check / replete Mag, K+
[ ] Choose early invasive vs non-invasive strategy. Strongly advocate cath lab if:
1. cardiogenic shock
2. severe CHF or LV dysfx
3. persistent rest pain
4. new/worsening mitral regurg
5. ventricular arrhythmias
[ ] Atorvastatin 80 mg PO when feasible

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