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.