Acute Coronary Syndrome (ACS) and Ischemic Heart Disease

Medical Directive ID: 
EMG-2019-004
Lead Contact Person: 
Tina Oliveira
Physician/Nurse Lead: 
Vico Dagnone
Program: 
Emergency Medicine Services
Approval By: 
Medical Advisory Committee
Original Effective Date: 
Wednesday, May 8, 2013
Revised Date: 
Friday, July 12, 2019
To Be Reviewed Date: 
Tuesday, July 12, 2022
This Medical Directive Applies to the following sites: 
LHSC-UH
LHSC-VH
This Medical Directive Applies to the following patient population: 
Out-Patients
Adults
Order: 

Registered Nurses and Registered Practical Nurses working in the Emergency Department will enter the electronic orders for and initiate the following orders as per the ACS Medical Directive Process Map/Algorithm:

1)An Electrocardiogram (ECG);

2)160 mg acetylsalicylic acid (Aspirin) chew x 1;

3)Oxygen titration if oxygen saturation is less than 94%; or if oxygen saturation is less than 88% forCO2 retainers;

4)ACS Lab Specimens;•CBC•Electrolytes•Glucose Random•Urea•Creatinine•Troponin•An INR/PTT test should be included if patient is on warfarin

5)Intravenous access using an appropriately sized angiocatheter;

6)Nitroglycerin:

No previous use: 0.4 mg sublingual, 1 spray if systolic blood pressure is greater than100mmHg•Previous use: 0.4 mg/ sublingual spray q5 minutes to a maximum of 3 sprays if systolicblood pressure remains greater than 100mmHg after each spray

Click the link to view the entire medical directive in detail: 

Signatures

SurnameKnown ByDate Signed
AguannoAlainaAug 29 2019 09:55:38:577PM
AndersonScottFeb 25 2020 05:10:28:960PM
ArbeauRyanJul 30 2019 10:28:30:407AM
BhimaniMunsifHave Not Signed
BrineMegganSep 24 2019 02:20:53:523PM
CaineSeanJul 30 2019 09:22:59:170AM
ChurchKaralynFeb 27 2020 02:58:47:747PM
CoomeGrantJan 12 2020 10:22:29:500PM
CunninghamChristyHave Not Signed
DagnoneRobert VicoJul 19 2019 11:50:27:977AM
DavisMatthewSep 27 2019 08:27:34:837AM
DongAlexAug 13 2019 11:40:15:060AM
DonovanKeithHave Not Signed
DoranSeanNov 19 2019 01:33:37:963AM
DreyerJonJul 30 2019 08:35:09:113AM
DukelowAdamJul 30 2019 02:57:28:320PM
EdmondsMarciaJul 18 2019 09:35:45:547PM
El-HalabiWaseemAug 30 2019 11:05:26:837AM
ElsadiSalmanMar 10 2020 11:30:03:390AM
ForristalChantalJul 25 2019 03:51:28:603PM
FotheringhamMarySep 8 2020 09:24:38:120PM
FoxcroftLauraAug 16 2019 02:17:55:640PM
FussJeffreySep 25 2019 11:18:32:677AM
GabrielJosephAug 6 2019 08:37:03:430PM
GhateGauriJul 30 2019 08:38:15:477AM
GiffinDawnAug 21 2019 02:58:34:607PM
GoelaKapilAug 14 2019 03:24:23:927PM
HamesHeatherJul 31 2019 11:47:21:613AM
HaneyElizabethJul 18 2019 12:20:53:620PM
HassaniBehzadFeb 21 2020 08:11:38:270AM
JonesAndrewApr 7 2020 12:42:48:027PM
KimJulieJul 29 2019 10:46:11:867AM
LamJasonAug 27 2019 10:16:57:047AM
LeeChing ChingJul 20 2019 04:10:10:313PM
LewellMichaelAug 7 2019 09:52:16:233AM
LinKangruiHave Not Signed
LoubaniTarekJul 30 2019 05:22:19:220PM
Luckett-GatopoulosSarahHave Not Signed
MacDonaldChristieAug 6 2019 12:48:23:337PM
MahngarKevinjeetSep 3 2019 11:59:32:307AM
MalSameerAug 13 2019 12:06:30:160AM
MaxwellH BrentHave Not Signed
McCauleyWilliamAug 12 2019 10:59:09:673AM
McConnellAllisonJul 18 2019 08:40:03:733PM
MeiwaldAllisonJul 30 2019 03:13:18:727PM
MillardWandaOct 1 2020 01:48:32:543PM
MurphyDavidJul 19 2019 10:58:39:463AM
MyslikFrankJul 18 2019 01:05:10:533PM
NgVictorAug 12 2020 03:45:10:960PM
OuelletteDavidMay 26 2020 11:02:28:053PM
PaceJacobJul 18 2019 10:52:19:103AM
ParkAndrewSep 3 2019 09:48:26:847AM
PatelNisargJul 18 2019 08:27:10:167AM
PeddleMichaelMar 5 2020 01:55:25:913AM
PillonSylviaNov 1 2019 11:33:08:553AM
PriceLauraAug 10 2019 04:27:35:760PM
PringleDerrickHave Not Signed
ReddyRameshHave Not Signed
ReganKellyOct 23 2019 05:17:48:560PM
RichardsonChristineOct 30 2019 08:36:45:420AM
RigganMorganAug 16 2019 09:29:04:467AM
RoebothamRoyAug 6 2019 12:03:40:640PM
SchappertAndrewFeb 27 2020 07:31:52:100AM
SedranRobertJul 29 2019 05:08:37:643PM
ShahAmitJul 22 2019 09:50:48:817AM
ShepherdLisaJul 30 2019 12:02:25:880PM
SkoretzTerrySep 26 2019 09:43:37:660AM
TheakstonKarlJul 18 2019 08:44:31:560AM
ThompsonDrewJul 30 2019 12:15:07:820PM
ValdisLaurenAug 8 2019 09:29:02:500PM
Van AarsenMarcusOct 3 2019 10:03:37:297AM
WilsonRyanHave Not Signed
WoolfreyKarenHave Not Signed
YanJustinJul 18 2019 07:20:57:120AM