Nurse Practitioner. CLINICAL PROTOCOL Chest Pain

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Nurse Practitioner. CLINICAL PROTOCOL Chest Pain"

Transcription

1 Nurse INTRODUCTION: Patients presenting with chest pain require rapid evaluation. Myocardial ischaemia should be considered in all patients presenting with chest pain. Assessment of pain type and referral, and response of pain to various interventions is important in differentiating between cardiac and non-cardiac chest pain. If the pain is cardiac in nature it is important to respond quickly to ensure the best possible outcome for the Pt. DIFFERENTIAL DAIGNOSIS: CVS CAUSES; AMI, unstable angina, aortic dissection, aortic aneurysm, pericarditis, aortic stenosis, mitral valve prolapse. RESP CAUSES; pulmonary embolism, pneumothorax, severe pneumonia. GI CAUSES; oesophageal spasm or rupture, gastric reflux, indigestion, perforated peptic ulcer. Musculoskeletal causes. Trauma or neoplasm. Psychiatric causes. Nurse Medical +/- Nurse Presenting History CLINICAL PRACTICE GUIDELINE Scope Chest pain responsive to protocols Identify patients suitable for outlined within this CP. NP clinical protocol. Refer unsuitable pts. to current GP. Chest pain unresponsive to treatment outlined within this CP. Evidence/suspicion of AMI or more serious cause of pain. Initial Assessment and Interventions Relevant past medical Hx and medication history Known allergies Pt. describes pain as squeezing, pressing, constricting, and heavy in central chest, +/- radiating to left arm, neck or jaw. Pt. may feel a sense of impending doom. Identify patients not suitable for NP CP and redirect to usual GP care +/- ED Identify patients not suitable for NP CP and redirect to usual GP care +/- ED

2 Physical examination Pain assessment Nurse Primary survey ABC Vital signs (T, P, R, BP), ECG if available. Signs of ST elevation refer GP/ED for thrombolysis. Assess pain: time of onset, position of pain including any radiation, description of pain, severity of pain, length of time pain has been present, frequency of pain episodes, what were you doing when the pain started, does anything make it better or worse, is it reproducible by palpation Any nausea, epigastric discomfort? Note any diaphoresis. Any SOB or dizziness Is the Pt. pale? Be aware of atypical signs/symptoms: No chest pain, but pain related to exertion or stress in the left arm or jaw. Epigastric discomfort. Unexplained fatigue. Indigestion, belching. Dizziness Pain in the right arm. Confusion. Assess associated vascular risk factors (eg strong family Hx). Asses level of pain using appropriate pain scale. Morphine 2.5 5mg IV then titrate to effect if required (GP only). Identify patients not suitable for NP CP exit CP and refer to current GP. Determine need for and type of analgesia required. Investigations Pathology Troponin, FBC, U&E, CK, LFT s Refer to GP for ongoing management. Imaging CXR if respiratory cause suspected. Diagnosis of cause of pain and application of correct treatment regime. Patient Education / Follow-up Follow up appointment Verbal instruction to patient: Review appointment may be indicated by pathology results; NP to contact patient to schedule follow-up Ensure patient understands problem, treatment and follow up.

3 Patient Education Medication instructions appointment. Nurse Verbal instruction and patient information handout if required and appropriate. Patient understanding of the problem, treatment and measures which may reduce the risk of ongoing complications. Verbal/written instructions from NP/GP Ensure patient understands problem, treatment and follow up Referrals Referrals may be required for specific patient problems or as required to: Physiotherapy Drug and alcohol counsellor Other problems outside of NP scope of practice Certificates Absence from work certificates Certificate of attendance Letter Copy of notes to GP / Specialist or acute care facility Interpretation of results and management decisions Patients with problems outside the NPs scope of practice are referred to appropriate health care providers. Ensure appropriate documentation completed Ensure continuity of care and referral to health care team GP hospital admission Outcome All medications will be stored, labelled and dispensed in accordance with hospital policy and relevant legislation

4 Initial management pathway Nurse Reassure Pt. Place Pt. in an upright position Give O2 2-4 L/nasal cannula if available. Assess vital signs (ECG if available) Assess chest pain Administer sublingual glyceryl trinitrate as prescribed Assess vital signs If no response to glyceryl trinitrate refer to current GP for further advice and management. If Pt. experiences a cardiac arrest commence basic life support/advanced life support as per facility protocol. Documentation and referral to current GP, transfer to nearest Emergency department. If no responsee after 5 mins Repeat sublingual glyceryl trinitrate Assess vital signs If no responsee after 5 mins Repeat sublingual glyceryl trinitrate Assess vital signs If pain is unresolved after 20 mins (3 doses of glyceryl trinitrate) CALL 000 FOR AN AMBULANCE Administer 300mgs Aspirin Reassess Pt. every 5 mins Administer analgesia if required Maintain airway if necessary Continue to reassure Pt.

5 Nurse Goals of Treatment Relief of symptoms Prevention of recurrence Prevention of complications Drug Formulary FORMULARY GLYCERYL TRINITRATE ASPIRIN Drug (generic name): Glyceryl Trinitrate Drug (generic name): Aspirin Dosage range: 400 mgs (spray) OR 600microgram (tablet) Dosage range: mg Route: oral (sublingual) Route: oral Frequency of administration: 5 minutely if pain persists Frequency of administration: immediately Duration of order: as required max of 3 metered doses, or 3 Duration of order: single dose tablets (1800 micrograms). Actions: immediate antiplatelet effect, produces complete Actions: Venodialting effects, reduction in venous return and inhibition of thromboxane-mediated platelet aggregation preload to the heart therefore reducing myocardial oxygen within 30 minutes. requirement. Indications for use: Acute chest pain with suspicion of acute Indications for use: Prevention and treatment of angina, coronary syndrome. acute heart failure associated with MI. Contraindications for use: Known NSAID hypersensitivity Contraindications for use: hypovolaemia, raised ICP, G6PD (esp. asthma). deficiency (risk of haemolytic anaemia). Adverse drug reactions: bleeding, GI upset, Adverse drug reactions: headache, flushing, palpitations, fainting, peripheral oedema. Rarely rebound angina. Unexpected representation NP Clinical Practice Evaluative strategies Review Patient Notes. Full audit of clinical events. NP Clinical Practice/Medical Report Audit

6 Nurse Key Terms NP Nurse CP Clinical Protocol GP General S4 Schedule of the drug administration act References 1. Australian Medicines handbook (internet). 2011, Nov. Accessed 2011 Dec 1 at 2. etg complete (internet). Melbourne: Therapeutic Guidelines Limited; 2011 Nov. Accessed 2011 Dec 1 at This CP was originally written by: Carol Jones Nurse Murray Medical Centre Mandurah Authorship, Endorsement and acknowledgement Reviewed and authorised by: Dr. Frank Reedman Jones MBBCh, DCH, DRCOG, FRACGP, FACRRM Murray Medical Centre: Primary Care Physician We acknowledge the authorship and input of : Dr. Eileen Bristol MBChB,MRCGP,DRCOG,FRACGP Murray Medical Centre: Primary Care Physician Carol Jones RN, RM, PGradDipNurse, NP Nurse Date Written: November 2011 Review Date: November 2013

Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine

Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics. Yen Tibayan, M.D. Division of Cardiovascular Medicine Is it really so? : Varying Presentations for ACS among Elderly, Women and Diabetics Yen Tibayan, M.D. Division of Cardiovascular Medicine Case Presentation 69 y.o. woman calls 911 with the complaint of

More information

Inpatient Anticoagulation Safety. To provide safe and effective anticoagulation therapy through a collaborative approach.

Inpatient Anticoagulation Safety. To provide safe and effective anticoagulation therapy through a collaborative approach. Inpatient Anticoagulation Safety Purpose: Policy: To provide safe and effective anticoagulation therapy through a collaborative approach. Upon the written order of a physician, Heparin, Low Molecular Weight

More information

Redefining the NSTEACS pathway in London

Redefining the NSTEACS pathway in London Redefining the NSTEACS pathway in London Sotiris Antoniou Consultant Pharmacist, Cardiovascular Medicine, Barts and The London NHS Trust and Project Lead, North East London Cardiovascular and Stroke Network

More information

CBT/OTEP 243 Aspirin Administration for ACS

CBT/OTEP 243 Aspirin Administration for ACS Seattle-King County EMS Seattle-King County Emergency Medical Services Division Public Health - Seattle/King County 401 5th Avenue, Suite 1200 Seattle, WA 98104 (206) 296-4693 February 2009 CBT/OTEP 243

More information

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations.

Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. INTRODUCTION Coronary Artery Disease leading cause of morbidity & mortality in industrialised nations. Although decrease in cardiovascular mortality still major cause of morbidity & burden of disease.

More information

Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust.

Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust. Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust. This Patient Group Direction (PGD) has been written

More information

Chest Pain. Acute Myocardial Infarction: Differential Diagnosis and Patient Management. Common complaint in ED. Wide range of etiologies

Chest Pain. Acute Myocardial Infarction: Differential Diagnosis and Patient Management. Common complaint in ED. Wide range of etiologies Acute Myocardial Infarction: Differential Diagnosis and Patient Management Presented By: Barbara Furry, RN-BC, MS, CCRN, FAHA Director The Center of Excellence in Education Director of HERO Chest Pain

More information

ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY

ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY Care Pathway Triage category ATRIAL FIBRILLATION PATHWAY ACCIDENT AND EMERGENCY DEPARTMENT/CARDIOLOGY AF/ FLUTTER IS PRIMARY REASON FOR PRESENTATION YES NO ONSET SYMPTOMS OF AF./../ TIME DURATION OF AF

More information

trust clinical guideline

trust clinical guideline CG01 VERSION 1.0 1/12 Guideline ID CG01 Version 1.1 Title Approved by Acute Coronary Syndromes and Stable Angina Clinical Effectiveness Group Date Issued 01/10/2014 Review Date 31/09/2017 Directorate Authorised

More information

RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department

RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department RISK STRATIFICATION for Acute Coronary Syndrome in the Emergency Department Sohil Pothiawala FAMS (EM), MRCSEd (A&E), M.Med (EM), MBBS Consultant Dept. of Emergency Medicine Singapore General Hospital

More information

INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure

INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure INTERDISCIPLINARY CLINICAL MANUAL Policy and Procedure TITLE: Management of Angina in NUMBER: Effective Date: January 2014 Page 1 of 6 Applies To: Interdisciplinary Clinical Manual Cardiac Rehabilitation

More information

ACLS PRE-TEST ANNOTATED ANSWER KEY

ACLS PRE-TEST ANNOTATED ANSWER KEY ACLS PRE-TEST ANNOTATED ANSWER KEY June, 2011 Question 1: Question 2: There is no pulse with this rhythm. Question 3: Question 4: Question 5: Question 6: Question 7: Question 8: Question 9: Question 10:

More information

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Version: 3.0 Ratified by: Medicines Committee Date ratified: 16 th November 2011 Name of originator/author: James

More information

Acute Coronary Syndrome. What Every Healthcare Professional Needs To Know

Acute Coronary Syndrome. What Every Healthcare Professional Needs To Know Acute Coronary Syndrome What Every Healthcare Professional Needs To Know Background of ACS Acute Coronary Syndrome (ACS) is an umbrella term used to cover a spectrum of clinical conditions that are caused

More information

EXHIBIT H SETTLEMENT ELIGIBILITY CRITERIA. a) pharmacy records reflecting the dispensing of Bextra and/or Celebrex to the Class Member; or

EXHIBIT H SETTLEMENT ELIGIBILITY CRITERIA. a) pharmacy records reflecting the dispensing of Bextra and/or Celebrex to the Class Member; or EXHIBIT H SETTLEMENT ELIGIBILITY CRITERIA 1. PRODUCT IDENTIFICATION DOCUMENTATION In order to be eligible for compensation under the Settlement Agreement, each Claimant must provide evidence of the Class

More information

Nurse Practitioner Emergency Services CLINICAL PRACTICE GUIDELINE

Nurse Practitioner Emergency Services CLINICAL PRACTICE GUIDELINE Scope Nurse Practitioner Wrist/forearm injury, pain, swelling or deformity Identify patients (Emergency) CPG Medical Practitioner +/-Nurse Practitioner Compound # / obvious fracture dislocation/ dislocation

More information

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour.

Adjunctive psychosocial intervention. Conditions requiring dose reduction. Immediate, peak plasma concentration is reached within 1 hour. Shared Care Guideline for Prescription and monitoring of Naltrexone Hydrochloride in alcohol dependence Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist,

More information

6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology

6/5/2014. Objectives. Acute Coronary Syndromes. Epidemiology. Epidemiology. Epidemiology and Health Care Impact Pathophysiology Objectives Acute Coronary Syndromes Epidemiology and Health Care Impact Pathophysiology Unstable Angina NSTEMI STEMI Clinical Clues Pre-hospital Spokane County EMS Epidemiology About 600,000 people die

More information

Cilostazol versus Clopidogrel after Coronary Stenting

Cilostazol versus Clopidogrel after Coronary Stenting Cilostazol versus Clopidogrel after Coronary Stenting Seong-Wook Park, MD, PhD, FACC Division of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul, Korea AMC, 2004 Background

More information

Minimum Standards for Chest Pain Evaluation. Implementation Support Guide Clinicans' Summary Consultation Edition (October 2011)

Minimum Standards for Chest Pain Evaluation. Implementation Support Guide Clinicans' Summary Consultation Edition (October 2011) Minimum Standards for Chest Pain Evaluation Implementation Support Guide Clinicans' Summary Consultation Edition (October 2011) Contents Executive Summary... 3 Objectives... 3 Background... 3 Mandatory

More information

URN: Family name: Given name(s): Address:

URN: Family name: Given name(s): Address: State of Queensland (Queensland Health) 2015 Licensed under: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Contact: Clinical_Pathways_Program@health.qld.gov.au Facility:... Clinical pathways

More information

A PATIENT S GUIDE TO SECONDARY PREVENTION IN ACUTE CORONARY SYNDROME (ACS)

A PATIENT S GUIDE TO SECONDARY PREVENTION IN ACUTE CORONARY SYNDROME (ACS) A PATIENT S GUIDE TO SECONDARY PREVENTION IN ACUTE CORONARY SYNDROME (ACS) This medicine is subject to additional monitoring. This will allow quick identification of new safety information. If you get

More information

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep

More information

Nurse Practitioner Emergency Services CLINICAL PRACTICE GUIDELINE

Nurse Practitioner Emergency Services CLINICAL PRACTICE GUIDELINE Nurse Practitioner Scope Adults with acute onset of diarrhoea +/- vomiting suitable for NP Medical Practitioner +/- Nurse Practitioner Underlying medical pathology / complex patient Chronic onset +/- recent

More information

The new Heart Failure pathway

The new Heart Failure pathway The new Heart Failure pathway An integrated and seamless Strategy Dr Sunil Balani Definition of Heart Failure The inability of the heart to pump blood at a rate commensurate with the requirements of metabolising

More information

Mr Davidson a 55 year old gentleman has been presented to the Medical Admissions Unit complaining of chest pain. Take a history from him.

Mr Davidson a 55 year old gentleman has been presented to the Medical Admissions Unit complaining of chest pain. Take a history from him. 7 Chest Pain History Ian Woolhouse Scenario Mr Davidson a 55 year old gentleman has been presented to the Medical Admissions Unit complaining of chest pain. Take a history from him. Script Hello Mr Davidson?

More information

Emergency Anaphylaxis Management: Opportunities for Improvement. Ronna Campbell, MD, PhD August 31, 2015

Emergency Anaphylaxis Management: Opportunities for Improvement. Ronna Campbell, MD, PhD August 31, 2015 Emergency Anaphylaxis Management: Opportunities for Improvement Ronna Campbell, MD, PhD August 31, 2015 disclosures Anaphylaxis Roundtable discussion held at the 2014 American College of Allergy, Asthma

More information

Pharmacology for the EMT

Pharmacology for the EMT Pharmacology for the EMT Presented by Wade Scoles RRT, NREMT Pharmacodynamics Everybody reacts to drugs differently Factors altering drug responses Age Body mass Sex Pathologic state Genetic factors Psychological

More information

Heparin Infusion. Clinical Practice Manual

Heparin Infusion. Clinical Practice Manual St Vincent s Hospital Sydney Clinical Practice Manual Section B Subject: Area: Medications Classification: Clinical Practice Relevant to: Clinical Staff Implementation Date: May 2002 Review Date: May 2003

More information

Chest Pain Evaluation (NSW Chest Pain Pathway)

Chest Pain Evaluation (NSW Chest Pain Pathway) Policy Directive Ministry of Health, SW 73 Miller Street orth Sydney SW 2060 Locked Mail Bag 961 orth Sydney SW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http//www.health.nsw.gov.au/policies/ Chest

More information

Management of Acute Coronary Syndrome / NSTEMI

Management of Acute Coronary Syndrome / NSTEMI CLINICAL GUIDELINE Management of Acute Coronary Syndrome / NSTEMI For use in (clinical areas): For use by (staff groups): For use for (patients): Document owner: Status: All clinical areas Medical and

More information

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF)

DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) MANAGEMENT of Atrial Fibrillation (AF) Key priorities Identification and diagnosis Treatment for persistent AF Treatment for permanent AF Antithrombotic

More information

Emergency Cardiac Care: Decision Support Tool #3 RN-Initiated Treatment of Chest Pain or Discomfort Suggestive of Acute Coronary Syndrome

Emergency Cardiac Care: Decision Support Tool #3 RN-Initiated Treatment of Chest Pain or Discomfort Suggestive of Acute Coronary Syndrome Emergency Cardiac Care: Decision Support Tool #3 RN-Initiated Treatment of Chest Pain or Discomfort Suggestive of Acute Coronary Syndrome Decision support tools are evidence based documents used to guide

More information

patient group direction

patient group direction DICLOFENAC v01 1/8 DICLOFENAC PGD Details Version 1.0 Legal category Staff grades Approved by POM Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner

More information

Emergency Treatment of an Anaphylactic Reaction in the Community Protocol

Emergency Treatment of an Anaphylactic Reaction in the Community Protocol Emergency Treatment of an Anaphylactic Reaction in the Community Protocol Reference Number: NHSCT/09/216 Responsible Directorate: Children s Services Replaces (if appropriate): Northern Trust Departmental

More information

If you do not wish to print the entire pre-test you may print Page 2 only to write your answers, score your test, and turn in to your instructor.

If you do not wish to print the entire pre-test you may print Page 2 only to write your answers, score your test, and turn in to your instructor. This is a SAMPLE of the pretest you can access with your AHA PALS Course Manual at Heart.org/Eccstudent using your personal code that comes with your PALS Course Manual The American Heart Association strongly

More information

Chest pain of recent onset

Chest pain of recent onset Chest pain of recent onset Assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin Issued: March 2010 NICE clinical guideline 95 guidance.nice.org.uk/cg95 NICE has

More information

Tips and Tricks to Demystify 12 Lead ECG Interpretation

Tips and Tricks to Demystify 12 Lead ECG Interpretation Tips and Tricks to Demystify 12 Lead ECG Interpretation Mission: Lifeline North Dakota Regional EMS and Hospital Conference Samantha Kapphahn, DO Essentia Health- Interventional Cardiology June 5th, 2014

More information

Bisoprolol in the Treatment of Heart Failure

Bisoprolol in the Treatment of Heart Failure Heart Failure Prescribing Guidelines Beta-Blocker Dose Titration Schedule Appendix 2A in the Treatment of Heart Failure Applicable to: All patients diagnosed with and commenced on bisoprolol. Patients

More information

Atrial Fibrillation (AF) Explained

Atrial Fibrillation (AF) Explained James Paget University Hospitals NHS Foundation Trust Atrial Fibrillation (AF) Explained Patient Information Contents What are the symptoms of atrial fibrillation (AF)? 3 Normal heartbeat 4 How common

More information

MODERATE SEDATION RECORD (formerly termed Conscious Sedation)

MODERATE SEDATION RECORD (formerly termed Conscious Sedation) (POLICY #DOC-051) Page 1 of 6 WELLSPAN HEALTH - YORK HOSPITAL NURSING POLICY AND PROCEDURE Dates: Original Issue: September 1998 Annual Review: March 2012 Revised: March 2010 Submitted by: Brenda Artz

More information

Clinical guideline Published: 24 March 2010 nice.org.uk/guidance/cg95

Clinical guideline Published: 24 March 2010 nice.org.uk/guidance/cg95 Chest pain of recent onset: assessment and diagnosis Clinical guideline Published: 24 March 2010 nice.org.uk/guidance/cg95 NICE 2010. All rights reserved. Your responsibility The recommendations in this

More information

PATIENT GROUP DIRECTION (PGD) ADMINISTRATION OF INHALED SALBUTAMOL FOR THE EMERGENCY TREATMENT OF ACUTE ASTHMA OR COPD EXACERBATION AT HMP FORD

PATIENT GROUP DIRECTION (PGD) ADMINISTRATION OF INHALED SALBUTAMOL FOR THE EMERGENCY TREATMENT OF ACUTE ASTHMA OR COPD EXACERBATION AT HMP FORD PATIENT GROUP DIRECTION (PGD) ADMINISTRATION OF INHALED SALBUTAMOL FOR THE EMERGENCY TREATMENT OF ACUTE ASTHMA OR COPD EXACERBATION AT HMP FORD Version Number: 01HMP Patient Group Direction originally

More information

Nature of disability. Hospital Details +91 44 22568009 +91 33 25111359. TEL : +91 22 6711 6618 / 09 l FAX : +91 22 26156290 +91 11 49637953

Nature of disability. Hospital Details +91 44 22568009 +91 33 25111359. TEL : +91 22 6711 6618 / 09 l FAX : +91 22 26156290 +91 11 49637953 Nature of disability Hospital Details TEL : +91 22 6711 6618 / 09 l FAX : +91 22 26156290 +91 11 49637953 +91 44 22568009 +91 33 25111359 Information Sheet for Guest Requiring Medical Clearance (to be

More information

Abstral Prescriber and Pharmacist Guide

Abstral Prescriber and Pharmacist Guide Abstral Prescriber and Pharmacist Guide fentanyl citrate sublingual tablets Introduction The Abstral Prescriber and Pharmacist Guide is designed to support healthcare professionals in the diagnosis of

More information

CH CONSCIOUS SEDATION

CH CONSCIOUS SEDATION Summary: CH CONSCIOUS SEDATION It is the policy of Carondelet Health that moderate conscious sedation of patients will be undertaken with appropriate evaluation and monitoring. Effective Date: 9/4/04 Revision

More information

Chest Pain in Young Athletes. Christopher Davis, MD, PhD Pediatric Cardiology Rady Children s Hospital San Diego cdavis@rchsd.

Chest Pain in Young Athletes. Christopher Davis, MD, PhD Pediatric Cardiology Rady Children s Hospital San Diego cdavis@rchsd. Chest Pain in Young Athletes Christopher Davis, MD, PhD Pediatric Cardiology Rady Children s Hospital San Diego cdavis@rchsd.org 858-966-5855 None Disclosures Chest Pain: the good news and the bad news:

More information

Ischemic Heart Disease: Angina Pectoris

Ischemic Heart Disease: Angina Pectoris Ischemic Heart Disease: Angina Pectoris Robert J. Straka, Pharm.D. FCCP Associate Professor University of Minnesota College of Pharmacy Minneapolis, Minnesota, USA strak001@umn.edu Learning Objectives

More information

Stowe School Medications Policy

Stowe School Medications Policy INTRODUCTION Most pupils will need medication at some stage of their school life. Although this will mainly be for short periods there are a few pupils with chronic conditions who may require regular medication

More information

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF

Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Leeds Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your

More information

Acute Coronary Syndrome for EMS

Acute Coronary Syndrome for EMS Acute Coronary Syndrome for EMS Rocco Altobelli BS, CCT-Paramedic, FP-C Alpine Institute, Kalispell, MT No part of this presentation may be reproduced or transmitted in any form or by any means, electronic

More information

Cardiovascular diseases. pathology

Cardiovascular diseases. pathology Cardiovascular diseases pathology Atherosclerosis Vascular diseases A disease that results in arterial wall thickens as a result of build- up of fatty materials such cholesterol, resulting in acute and

More information

**Form 1: - Consultant Copy** Telephone Number: Fax Number: Email: Author: Dr Bernard Udeze Pharmacist: Claire Ault Date of issue July 2011

**Form 1: - Consultant Copy** Telephone Number: Fax Number: Email: Author: Dr Bernard Udeze Pharmacist: Claire Ault Date of issue July 2011 Effective Shared Care Agreement for the treatment of Dementia in Alzheimer s Disease Donepezil tablets / orodispersible tablets (Aricept / Aricept Evess ) These forms (1 and 2) are to be completed by both

More information

Heart Attack: What You Need to Know

Heart Attack: What You Need to Know A WorkLife4You Guide Heart Attack: What You Need to Know What is a Heart Attack? The heart works 24 hours a day, pumping oxygen and nutrient-rich blood to the body. Blood is supplied to the heart through

More information

STUDY GUIDE 1.1: NURSING DIAGNOSTIC STATEMENTS AND COMPREHENSIVE PLANS OF CARE

STUDY GUIDE 1.1: NURSING DIAGNOSTIC STATEMENTS AND COMPREHENSIVE PLANS OF CARE STUDY GUIDE 1.1: NURSING DIAGNOSTIC STATEMENTS AND COMPREHENSIVE PLANS OF CARE WHAT IS A NURSING DIAGNOSIS? A nursing diagnosis is a clinical judgment about individual, family, or community responses to

More information

PACKAGE LEAFLET: INFORMATION FOR THE USER. ADRENALINE (TARTRATE) STEROP 1 mg/1 ml Solution for injection. Adrenaline (Levorenine, Epinephrine)

PACKAGE LEAFLET: INFORMATION FOR THE USER. ADRENALINE (TARTRATE) STEROP 1 mg/1 ml Solution for injection. Adrenaline (Levorenine, Epinephrine) PACKAGE LEAFLET: INFORMATION FOR THE USER ADRENALINE (TARTRATE) STEROP 1 mg/1 ml Solution for injection Adrenaline (Levorenine, Epinephrine) Read all of this leaflet carefully before you start using this

More information

Tilt Protocol. Protocol

Tilt Protocol. Protocol Tilt Protocol Chelsea and Westminster Hospital Guidelines for diagnosing syncope Guidelines for the diagnosis and management of syncope have been published by the relevant task force of the European Society

More information

Chest Pain Pathway. Temp ( o c) Dose Route Prescriber Signature

Chest Pain Pathway. Temp ( o c) Dose Route Prescriber Signature ECG Recorded at hrs, Chest Pain Pathway Care Pathway Triage Category Review by...(name) (designation) at hrs Contents: Page 2 - ECG - ST elevation or presumed new left bundle branch block (LBBB). Consider

More information

Carvedilol in the Treatment of Heart Failure

Carvedilol in the Treatment of Heart Failure Appendix 2B Heart Failure Prescribing Guidelines Rotherham PCT Applicable to: Carvedilol in the Treatment of Heart Failure All patients diagnosed with and commenced on carvedilol. Patients not discharged

More information

And the. Two types of orders:

And the. Two types of orders: 1 PHARMACOLOGY And the EMT-B 2 MEDICAL DIRECTION Must have Dr. s orders to administer any drug to a Pt Local medical director can override any state set protocols Two types of orders: On-line : verbal

More information

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program

The TIRF REMS Access program is a Food and Drug Administration (FDA) required risk management program Subject: Important Drug Warning Announcement of a single shared REMS (Risk Evaluation and Mitigation Strategy) program for all Transmucosal Immediate Release Fentanyl (TIRF) products due to the potential

More information

Advanced Cardiovascular Life Support Case Scenarios

Advanced Cardiovascular Life Support Case Scenarios Advanced Cardiovascular Life Support Case Scenarios ACLS Respiratory Arrest Case Out-of-Hospital Scenario You are a paramedic and respond to the scene of a possible cardiac arrest. A young man lies motionless

More information

Clinical Performance Director of Nursing Allison Bussey

Clinical Performance Director of Nursing Allison Bussey PGD 0314 Patient Group Direction Administration of Adrenaline (Epinephrine) 1:1000 (1mg/ml) Injection By Registered Nurses employed by South Staffordshire & Shropshire Healthcare Foundation NHS Trust This

More information

Thrombolytics (Reteplase, Tenecteplase) Rpa/Tnk and Adjunctive Heparin

Thrombolytics (Reteplase, Tenecteplase) Rpa/Tnk and Adjunctive Heparin PRESENTATION Vials of reteplase 10 units for reconstitution with 10ml water for injection. Vials of tenecteplase 10,000 units for reconstitution with 10ml water for injection, or 8,000 units for reconstitution

More information

EPINEPHRINE AUTO-INJECTOR TRAINING POLICY ALLERGIC REACTION / ANAPHYLAXIS

EPINEPHRINE AUTO-INJECTOR TRAINING POLICY ALLERGIC REACTION / ANAPHYLAXIS Page 1 of 1 EPINEPHRINE AUTO-INJECTOR TRAINING POLICY ALLERGIC REACTION / ANAPHYLAXIS All members/employees of (service) affiliate number must complete DOH training module #004124 and be familiar with

More information

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information)

Acute Myocardial Infarction (the formulary thrombolytic for AMI at AAMC is TNK, please see the TNK monograph in this manual for information) ANNE ARUNDEL MEDICAL CENTER CRITICAL CARE MEDICATION MANUAL DEPARTMENT OF NURSING AND PHARMACY Guidelines for Use of Intravenous Alteplase (Tissue Plasminogen Activator (t-pa)), Activase in the Treatment

More information

Upstate University Health System Medication Exam - Version A

Upstate University Health System Medication Exam - Version A Upstate University Health System Medication Exam - Version A Name: ID Number: Date: Unit: Directions: Please read each question below. Choose the best response for each of the Multiple Choice and Medication

More information

Tracy Walker, RN, BSN, CCRP Research Nurse OHSU Knight Cancer Institute. 503-346-1183 walkertr@ohsu.edu

Tracy Walker, RN, BSN, CCRP Research Nurse OHSU Knight Cancer Institute. 503-346-1183 walkertr@ohsu.edu Tracy Walker, RN, BSN, CCRP Research Nurse OHSU Knight Cancer Institute 503-346-1183 walkertr@ohsu.edu Exercise Questions to Keep in Mind Is there an adverse event? What is the severity? What is the relationship

More information

Protocol for the management of atrial fibrillation in primary care

Protocol for the management of atrial fibrillation in primary care Protocol for the management of atrial fibrillation in primary care Protocol for the management of atrial fibrillation in primary care Contents Page no Definition 2 Classification of AF 2 3 Identification

More information

NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses

NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses NHS FORTH VALLEY Multiple Sclerosis Service Management of MS Relapses Approved 22/06/2010 Version Version 2 Date of First Issue 2002 Review Date 10/05/2016 Date of Issue 01/02/2010 EQIA Yes 22.06.10 Author

More information

Thrombolysis from a nursing perspective. Gill Cluckie Stroke specialist nurse Guy s and St. Thomas NHS Foundation Trust

Thrombolysis from a nursing perspective. Gill Cluckie Stroke specialist nurse Guy s and St. Thomas NHS Foundation Trust Thrombolysis from a nursing perspective Gill Cluckie Stroke specialist nurse Guy s and St. Thomas NHS Foundation Trust First hour managing the infusion First 24 hours: Observations Complication identification

More information

Guideline for Management of Primary Headache in Adults

Guideline for Management of Primary Headache in Adults Guideline for Management of Primary Headache in Adults July 2012 This summary provides an evidence-based practical approach to assist primary health care providers in the diagnosis and management of adult

More information

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation

Planning: Patient Goals and Expected Outcomes The patient will: Remain free of unusual bleeding Maintain effective tissue perfusion Implementation Obtain complete heath history including allergies, drug history and possible drug Assess baseline coagulation studies and CBC Assess for history of bleeding disorders, GI bleeding, cerebral bleed, recent

More information

Emergency Scenario. Chest Pain

Emergency Scenario. Chest Pain Emergency Scenario Chest Pain This emergency scenario reviews chest pain in a primary care patient, and is set up for roleplay and case review with your staff. 1) The person facilitating scenarios can

More information

ABCs of ACS: ACUTE CORONARY SYNDROME Claudine Hagan, RN MPA

ABCs of ACS: ACUTE CORONARY SYNDROME Claudine Hagan, RN MPA ABCs of ACS: ACUTE CORONARY SYNDROME Claudine Hagan, RN MPA Objectives Define acute coronary syndrome Describe the pathophysiology of acute myocardial infarction Describe the contributing factors to acute

More information

Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI)

Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI) Novartis Gilenya FDO Program Clinical Protocol and Highlights from Prescribing Information (PI) Highlights from Prescribing Information - the link to the full text PI is as follows: http://www.pharma.us.novartis.com/product/pi/pdf/gilenya.pdf

More information

Proposed improvements to acute medical and chest pain patient pathways

Proposed improvements to acute medical and chest pain patient pathways Proposed improvements to acute medical and chest pain patient pathways June 2016 Contents Contents... 2 Executive summary... 3 Introduction... 4 How acute medicine and chest pain services are currently

More information

Review of Pharmacological Pain Management

Review of Pharmacological Pain Management Review of Pharmacological Pain Management CHAMP Activities are possible with generous support from The Atlantic Philanthropies and The John A. Hartford Foundation The WHO Pain Ladder The World Health Organization

More information

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure.

Acute heart failure may be de novo or it may be a decompensation of chronic heart failure. Management of Acute Left Ventricular Failure Acute left ventricular failure presents as pulmonary oedema due to increased pressure in the pulmonary capillaries. It is important to realise though that left

More information

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Dardo E. Ferrara MD Cardiac Electrophysiology North Cascade Cardiology PeaceHealth Medical Group Which anticoagulant

More information

What Medical Emergencies Should a Dental Office be Prepared to Handle?

What Medical Emergencies Should a Dental Office be Prepared to Handle? What Medical Emergencies Should a Dental Office be Prepared to Handle? Gary Cuttrell, DDS, JD, University of NM Division of Dental Services Santiago Macias, MD, First Choice Community Healthcare Dentists

More information

Version Number: 5. Patient Group Direction originally drawn up by: Reviewed by: Patient Group direction authorised by: Medical Lead

Version Number: 5. Patient Group Direction originally drawn up by: Reviewed by: Patient Group direction authorised by: Medical Lead PATIENT GROUP DIRECTION (PGD) FOR THE SUPPLY AND/OR ADMINISTRATION OF NALOXONE HYDROCHLORIDE INJECTION BY REGISTERED NURSES WORKING IN COMMUNITY AND INPATIENT SUBSTANCE MISUSE TEAMS Version Number: 5 Patient

More information

CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN

CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN Low back pain is very common, up to 90+% of people are affected by back pain at some time in their lives. Most often back pain is benign and

More information

Introduction. Background to this event. Raising awareness 09/11/2015

Introduction. Background to this event. Raising awareness 09/11/2015 Introduction Primary Care Medicines Governance HSCB Background to this event New class of medicines Availability of training Increasing volume of prescriptions Reports of medication incidents Raising awareness

More information

Parliament of Australia Department of Parliamentary Services

Parliament of Australia Department of Parliamentary Services Parliament of Australia Department of Parliamentary Services Operating Policies and Procedures No. 2 Role of the Nurses Centre Date: 17 February 2011 Expiry: December 2012 Approved: Secretary File No:

More information

Community health care services Alternatives to acute admission & Facilitated discharge options. Directory

Community health care services Alternatives to acute admission & Facilitated discharge options. Directory Community health care services Alternatives to acute admission & Facilitated discharge options Directory Introduction The purpose of this directory is to provide primary and secondary health and social

More information

Pre-Screening and Risk Stratification

Pre-Screening and Risk Stratification Pre-Screening and Risk Stratification Chapter 1, 2 and 3 ACSM What is involved in the prescreening process? The Basic Goal To determine if it is safe for an individual to start an exercise program, what

More information

Atrial fibrillation. Quick reference guide. Issue date: June 2006. The management of atrial fibrillation

Atrial fibrillation. Quick reference guide. Issue date: June 2006. The management of atrial fibrillation Quick reference guide Issue date: June 2006 Atrial fibrillation The management of atrial fibrillation Developed by the National Collaborating Centre for Chronic Conditions Contents Contents Patient-centred

More information

CHAPTER 21 QUIZ. Handout 21-1. Write the letter of the best answer in the space provided.

CHAPTER 21 QUIZ. Handout 21-1. Write the letter of the best answer in the space provided. Handout 21-1 QUIZ Write the letter of the best answer in the space provided. 1. A severe form of allergic reaction is called A. an allergen. C. epinephrine. B. anaphylaxis. D. an immune reaction. 2. Harmless

More information

Maintenance of abstinence in alcohol dependence

Maintenance of abstinence in alcohol dependence Shared Care Guideline for Prescription and monitoring of Acamprosate Calcium Author(s)/Originator(s): (please state author name and department) Dr Daly - Consultant Psychiatrist, Alcohol Services Dr Donnelly

More information

GUIDELINE FOR ADMINISTRATION OF FENTANYL FOR PAIN RELIEF IN LABOUR

GUIDELINE FOR ADMINISTRATION OF FENTANYL FOR PAIN RELIEF IN LABOUR GUIDELINE FOR ADMINISTRATION OF FENTANYL FOR PAIN RELIEF IN LABOUR INTRODUCTION Intravenous (IV) Fentanyl is a good option for pain management during labour and should be administered in a safe and competent

More information

American Heart Association ACLS Pre-Course Self Assessment Dec., 2006. ECG Analysis. Name the following rhythms from the list below:

American Heart Association ACLS Pre-Course Self Assessment Dec., 2006. ECG Analysis. Name the following rhythms from the list below: American Heart Association ACLS Pre-Course Self Assessment Dec., 2006 ECG Analysis This pre-test is exactly the same as the pretest on the ACLS Provider manual CD. This paper version can be completed in

More information

Osama Jarkas. in Chest Pain Patients. STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015

Osama Jarkas. in Chest Pain Patients. STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015 STUDENT NAME: Osama Jarkas DATE: August 10 th, 2015 PROJECT TITLE: Analysis of ECG Exercise Stress Testing and Framingham Risk Score in Chest Pain Patients PRIMARY SUPERVISOR NAME: Dr. Edward Tan DEPARTMENT:

More information

Stroke Care First week

Stroke Care First week Stroke Care First week Florence Nightingale (1820 1910) Stroke Unit Dedicated personnel trained in stroke management Stepwise guidelines supported by explicit checklists Continuous monitoring available

More information

Assessment, diagnosis and specialist referral of adults (>16 years) with an episode of transient loss of consciousness (TLoC) or a blackout.

Assessment, diagnosis and specialist referral of adults (>16 years) with an episode of transient loss of consciousness (TLoC) or a blackout. Assessment, diagnosis and specialist referral of adults (>16 years) with an episode of transient loss of consciousness (TLoC) or a blackout. TLoC is common huge variation in management range of clinicians

More information

S9 Administer thrombolytic treatment in acute ischaemic stroke

S9 Administer thrombolytic treatment in acute ischaemic stroke S9 Administer thrombolytic treatment in acute ischaemic Screening and initiating treatment, overseeing competency of treatment About this workforce competence This competence is about the emergency administration

More information

Cardiology ARCP Decision Aid August 2014

Cardiology ARCP Decision Aid August 2014 Cardiology ARCP Decision Aid August 2014 The table that follows includes a column for each training year which documents the targets that have to be achieved for a satisfactory ARCP outcome at the end

More information

THE MUSCLE AND CARDIOVASCULAR SYSTEM

THE MUSCLE AND CARDIOVASCULAR SYSTEM THE MUSCLE AND CARDIOVASCULAR SYSTEM The focus of this week s lab will be pathology of the cardiovascular system. The cardiovascular system is composed of the heart and its associated structures as well

More information

Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology

Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology Cardiology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Cardiology Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89) The diabetes mellitus codes are combination codes

More information

Team Leader. Ensures high-quality CPR at all times Assigns team member roles Ensures that team members perform well. Bradycardia Management

Team Leader. Ensures high-quality CPR at all times Assigns team member roles Ensures that team members perform well. Bradycardia Management ACLS Megacode Case 1: Sinus Bradycardia (Bradycardia VF/Pulseless VT Asystole Out-of-Hospital Scenario You are a paramedic and arrive on the scene to find a 57-year-old woman complaining of indigestion.

More information