Patients with UA/NSTEMI at medium or high risk should be admitted to an intensive (cardiac) or intermediate care unit; patients at low risk should be admitted to a monitored bed, preferably in a cardiac step-down unit.^[2] In these settings, continuous electrocardiographic monitoring (i.e., telemetry) is used to detect tachyarrhythmias, alterations in atrioventricular and intraventricular conduction, and changes in ST-segment deviation. Bed rest should be prescribed initially. Ambulation, as tolerated, is permitted if the patient has been stable without recurrent chest discomfort for at least 12 to 24 hours. It is advisable to provide supplemental oxygen to patients with cyanosis or extensive rales and when arterial oxygen saturation, measured by oximetry, declines below 90%.

Relief of chest pain is an initial goal of treatment. In patients with persistent pain despite therapy with nitrates and beta blockers (see later), morphine sulfate by intravenous bolus …