Approach to CCS

Step I: Stablize the patient

Step II: Physical Examination: complete vs. focus

Step III: Diagnostic Workup: time is the key
Pulse oxy
CXR, portable
EKG
Finger tip glucose
CT head
cardiac enzymes
PEFR in asthma patients
drug levels
serum amylase and lipase levels
blood alcohol level
coagulation studies
LFTs

Step IV: triage the patient
Vitals
Activities
Is/Os
Diets
Daily weights
Monitoring

Labs
IV fluids
Medications
1. change IV to PO whenever possible
2. Nebulizer to MDI when pt is stable
3. FOBT before initiation of heparin/warfarin
4. PRN meds
5. adjust doses

Step V:
educate patients and family
counsel patient on excercise, no smoking, no alcohol, no drug use, safe driving, safe sex, etc.