1. GENERAL ORDERS PAGE CATH LAB (*50--State "This is an ALPHA page") AS SOON AS POSSIBLE Complete STEMI Checklist Start 1-2 venous access lines Nasal oxygen at ____ L/min Place patient on transport monitor with defibrillator pads on patient MEDICATIONS (STEMI KIT in Pyxis) ASA allergy or contraindication? N Y __________________ ASA, 324 mg (4 tabs) po chewed now PRASUGREL CONTRAINDICATION (age>75, wt <60 kg, prior CVA or TIA, high risk for bleeding) Y N if no contraindication, PRASUGREL, 60 mg po now If prasugrel contraindication, then CLOPIDOGREL (Plavix)(if no contraindication), 600 mg po now HEPARIN, 60 units/kg IV bolus (max dose 4000 units) Dose ___________units then IV drip (25,000 units/250ml D5W) @ 12 units/kg/hr (max dose 1000 units) Dose ________Units/hr STAT LABS Heme 18, basic metabolic, PT, PTT, U/A, Mg, hepatic panel, lipid panel, LDL, STBB CK, CK-MB, Troponin I ALL OF THE ABOVE (ORDERS, MEDICATIONS, LABS) ALL OF THE ABOVE SHOULD BE COMPLETED PRIOR TO LEAVING THE ED Additional treatments if time allows (should not delay departure) ATORVASTATIN, (Lipitor) 80 mg po now NITROGLYCERIN, (100mg/250ml D5W) 3cc/hr initial IV dose, titrate to relief with SBP >100 mmHg MORPHINE, _____mg IV x1 PRN (after consent for cath signed)

3. 40 yo male who presented to ED via EMS with CP. Initial EMS ECGs not quite diagnostic. ECG in ED diagnostic. Went to cath lab, 100% LAD opened Dispatched8:11 Arrival8:18 EMS ECG8:24 Departure8:31 Time to ED:8:44 Time to ECG:8:451 min Time to ALPHA8:495 min Time to CCL9:0420 min Time to balloon9:1026 min EMS Arrival to Reperfusion (E2R)52 Min EMS ECG to Reperfusion (R2R)46 Min D2B26 min 8-19-2010