Managing Non-Traumatic Chest Pain
Step 1: Initial Response
Bringing a Defibrillator and Ensuring Patient Safety
- Immediate Defibrillator: Carry a defibrillator to patients displaying potential heart attack symptoms and stay with them until hospital staff takes over.
Step 2: Patient Assessment
Evaluating Vital Signs and Identifying Red Flags
- Vital Signs Assessment: Check the patient's vital signs.
- Red Flag Criteria: If any major issues or the following red flags are present:
- ST-Elevation Myocardial Infarction (STEMI)
- Pulmonary Embolism
- Aortic Dissection
- Pneumonia
- Respiratory Rate Less Than 10 or Over 30 Breaths per Minute
- Oxygen Saturation (SpO2) Less Than 94% on Room Air
Step 3: Cardiac Assessment
Determining if Chest Pain May Be Cardiac
- Chest Pain Evaluation: Assess characteristics such as location, duration, radiation, and aggravating or alleviating factors.
- Patient History: Inquire about any history of coronary heart disease.
Step 4: Additional Symptoms
Noting Associated Features and Possible Causes
- Accompanying Symptoms: Observe for nausea, vomiting, sweating, pallor, and cough.
- Consider Breathlessness: If breathlessness is present as the predominant symptom, explore other potential causes.
Step 5: Clinical Assessment
Evaluating Hemodynamic Status and Identifying Non-Coronary Causes
- Hemodynamic Problems: Check for heart failure, cardiogenic shock, or non-coronary issues, e.g., aortic dissection.
- Rule Out Other Conditions: If ACS is unlikely based on clinical examination and a 12-lead ECG, consider alternative acute conditions like pulmonary embolism or pneumonia.
Step 6: Monitoring
Continuous Monitoring and Diagnostic Tests
- Measure Vital Signs: Record pulse, respiratory rate, and blood pressure.
- Arrhythmia Assessment: Use an ECG to monitor for arrhythmias.
- ECG Transmission: If available, transmit the ECG to the hospital following local protocols.
- Oxygen Saturation: Assess oxygen saturation and provide oxygen only if SpO2 is below 94% on room air.
- Pain Assessment: Evaluate the patient's pain, measure the pain score, and consider providing analgesia.
- Documentation: Complete all necessary documentation.