New CPU Guidelines

In discussion with cardiology, we have agreed to change the criteria for observation in the CPU to maximize the efficiency of the unit and patient safety.  We have agreed on the following:
The CPU can now take patients with chest pain suspicious for ACS who are:

Inclusion:

under 70
have the ability to exercise (consider walking them around the ED)

Exclusion:

multiple comorbid illnisses that complicate diagnosis (eg. lung cancer, severe copd)
syncopal or near syncopal symptoms
significant component of palpitations (if they seem very incidental it might be ok)
rest pain (do not put patients with unstable angina there)
ischemic ecg, dynamic changes
alternate diagnoses still likely (eg. pending PE, dissection, pna workup)
In essence, this means that we can put patient who would have been characterized as “intermediate” or even “high” risk previously as long as they are relatively healthy – the 60 year old with a stent and a weak story, the 55 year old with multiple risk factors and stable inferior flipped t waves are now ok.