CORE MODULE: Initial Evaluation and Triage
Patient With Known Or Suspected Ischemic Heart Disease (IHD)
Obtain Brief History And Physical Examination [B]
Emergency Interventions [Cardiac monitor; O2; Aspirin;IV access; 12 lead ECG; Obtain Lab tests; SL-NTG; Adequate analgesia; ACLS intervention; Chest X-ray, Transportation]
Ongoing/Recent Symptoms Suggestive Of Ischemia? [C]
Obtain 12-Lead ECG, If Not Already Done [D]
Is Patient's Status An Emergency Based On Vital Signs And Appearance? [E] Emergency Treatment [F]
Definite or Probable Acute Coronary Syndrome (ACS)? [G]
Continue to Monitor Patients at Low-Risk for Death or MI for 4-8 hrs [I]
Are There Recurrent Symptoms Suggestive of Ischemia, or Diagnostic ECG and/or Elevated Cardiac Markers? [J] Is There ST-Segment Elevation Or New or Presumably New Left Bundle Branch Block (LBBB) With Ongoing/Recent Symptoms? [H] Admit; Go to Module A )Suspected Acute MI, ST-segment elevation MI/LBBB
Non-Invasive Cardiac Stress Test [K] Admit; Go to Module B ( Unstable Angina/ non-ST-segment elevation MI)
Stress Test Results Indicate Diagnosis of CAD with High/Intermediate Risk Features [L]
Refer to Cardiology for possible angiography
Does The Patient Have Documented IHD Or A High Probability Of CAD? [M] Does Patient Have Symptoms (angina)? Go to Module C (Stable Angina)
Go to Module G (Follow-up and Secondary Prevention)
Consider noninvasive evaluation if not already done; Go to Module F
Asymptomatic with abnormal screening test; Go to Module D
Re-evaluate; Consider referral to Cardiology