CHEST PAIN
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any, none, or all of the following: sub-sternal chest pain, chest pressure, shortness of breath, diaphoresis, nausea, and vomiting, syncope, radiating pain to the jaw and arms, a feeling of impending doom, and history of cardiac problems.
EMPHASIS ON PATIENT CARE
Airway management, adequate perfusion and oxygenation, pain control and early transportation to an appropriate facility
1. Primary Management - Assess ABC’s and manage as indicated.
a. Obtain baseline set of vital signs (HR, B/P, SpO2, BGL, etc.)
b. Cardiac monitoring, oxygen administration if SpO2 <94%, and obtain a 12-lead ECG if possible.
2. Transport the patient to an appropriate medical facility. Consider AEMT/ALS intercept.
3. Secondary Management - History, physical exam, vital signs
a. Obtain history including Thrombolytic Therapy Checklist.
b. If suspected AMI chest pain, administer ASPIRIN [325 mg PO]. Chewed.
c. If applicable, contact online medical control for administration of the patient’s own NITROGLYCERIN every 3-5 minutes up to 3 times if
B/P >100mmHg systolic, HR >60 and < 140 and relief of symptom occurs.
AEMT
1. In route, initiate IV/IO access; consider second IV if patient condition indicates the need and time permits.
A. If systolic B/P <90mmHg, infuse at rate to attempt to raise BP.
B. If 2 unsuccessful IV attempts in patients who may be candidates for thrombolytics,
contact medical control for further attempts.
CHEST PAIN
AEMT
2. If patient does not have nitroglycerin and is still in pain, BP > 100mmHg systolic, and HR > 60bpm, and <140bpm, consider NITROGLYCERIN [0.4 mg SL] every 3-5 minutes up to 3 times if IV is established. If no relief after initial NTG discontinue further doses.
3. DO NOT GIVE NITROGLYCERIN IF: patient has taken Erectile Dysfunction medications in the past 48 hours (i.e. Viagra, Cialis, Levitra, etc.).
4. If transport is prolonged, contact medical control for additional Nitroglycerin administration.
5. Administer narcotic (Fentanyl) analgesics according to PAIN MANAGEMENT GUIDELINES.
PARAMEDIC
1. 12 lead ECG should be completed within the first 3-5 minutes of patient contact on chest pain patients.
2. Interpret the 12-lead ECG and transmit per transmission protocol:
a. If STEMI initiate transport to appropriate STEMI center and perform additional treatments in-route.
b. Hold NTG if EKG shows inferior MI pattern and consider Right sided EKG
3. Serial 12 leads should be completed on all chest pain patients. A minimum of two 12 leads should be performed on all chest pain patients but should not delay transport to definitive care.
4. For pain management, Follow Pain Management Guidelines.
5. See appropriate guidelines for Ventricular Tachycardia (VT) with a Pulse and/or Wide Complex Tachycardias.
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any, none, or all of the following: sub-sternal chest pain, chest pressure, shortness of breath, diaphoresis, nausea, and vomiting, syncope, radiating pain to the jaw and arms, a feeling of impending doom, and history of cardiac problems.
EMPHASIS ON PATIENT CARE
Airway management, adequate perfusion and oxygenation, pain control and early transportation to an appropriate facility
1. Primary Management - Assess ABC’s and manage as indicated.
a. Obtain baseline set of vital signs (HR, B/P, SpO2, BGL, etc.)
b. Cardiac monitoring, oxygen administration if SpO2 <94%, and obtain a 12-lead ECG if possible.
2. Transport the patient to an appropriate medical facility. Consider AEMT/ALS intercept.
3. Secondary Management - History, physical exam, vital signs
a. Obtain history including Thrombolytic Therapy Checklist.
b. If suspected AMI chest pain, administer ASPIRIN [325 mg PO]. Chewed.
c. If applicable, contact online medical control for administration of the patient’s own NITROGLYCERIN every 3-5 minutes up to 3 times if
B/P >100mmHg systolic, HR >60 and < 140 and relief of symptom occurs.
AEMT
1. In route, initiate IV/IO access; consider second IV if patient condition indicates the need and time permits.
A. If systolic B/P <90mmHg, infuse at rate to attempt to raise BP.
B. If 2 unsuccessful IV attempts in patients who may be candidates for thrombolytics,
contact medical control for further attempts.
CHEST PAIN
AEMT
2. If patient does not have nitroglycerin and is still in pain, BP > 100mmHg systolic, and HR > 60bpm, and <140bpm, consider NITROGLYCERIN [0.4 mg SL] every 3-5 minutes up to 3 times if IV is established. If no relief after initial NTG discontinue further doses.
3. DO NOT GIVE NITROGLYCERIN IF: patient has taken Erectile Dysfunction medications in the past 48 hours (i.e. Viagra, Cialis, Levitra, etc.).
4. If transport is prolonged, contact medical control for additional Nitroglycerin administration.
5. Administer narcotic (Fentanyl) analgesics according to PAIN MANAGEMENT GUIDELINES.
PARAMEDIC
1. 12 lead ECG should be completed within the first 3-5 minutes of patient contact on chest pain patients.
2. Interpret the 12-lead ECG and transmit per transmission protocol:
a. If STEMI initiate transport to appropriate STEMI center and perform additional treatments in-route.
b. Hold NTG if EKG shows inferior MI pattern and consider Right sided EKG
3. Serial 12 leads should be completed on all chest pain patients. A minimum of two 12 leads should be performed on all chest pain patients but should not delay transport to definitive care.
4. For pain management, Follow Pain Management Guidelines.
5. See appropriate guidelines for Ventricular Tachycardia (VT) with a Pulse and/or Wide Complex Tachycardias.