Chest pain that suggests myocardial infarction is extremely variable. High risk factors include male, over 30 years old, diabetes, hypertension, previous MI. Suspicious symptoms may include pain referring into arms or jaw, dizziness, nausea/vomiting, shortness of breath, syncope, or tightness in chest.

1. Reassure patient and place at rest in position of comfort.
2. Perform patient assessment and ABC's.
3. Administer oxygen via most appropriate device to insure adequate oxygenation.
4. Monitor vital signs in accordance with S.O.P. protocol.
5. Contact Medical Control and request administration of Aspirin 324 mg PO (if no contraindications exist).
6. Under Medical Control direction you may assist the patient in administering the patient's own Nitroglycerin.
7. Do Not delay transport. Request Paramedic Intercept ASAP
8. Transport without lights and sirens to decrease patient anxiety levels.

INTERMEDIATE LIFE SUPPORT

1. Initiate IV of NS. IV attempts shall not exceed a total of two (2) attempts on patients who are candidates for thrombolysis.
2. Once IV access has been obtained and the patients BP is at least 100 systolic;
   1. Contact Medical Control request administration of Nitroglycerin 0.4 mg SL if pain persists, every 5 minutes up to 1.2 mg (3 doses).
   2. If pain persists after 1.2 mg NTG, contact Medical Control request administration of Morphine Sulfate 2mg Slow IV push, every 5 min, up to 10 mg. or unitl relief of pain.
   3. EMT must monitor BP between each dose of medication, if BP falls below 100 systolic, administer fluid bolus to maintain BP.
3. Request Paramedic Intercept for ECG monitoring, and/or additional medications may be indicated (antidysrhythmics, vasopressors, etc.) also in the event of sudden cardiac death, multiple ILS/ALS providers will increase the chances of succesful resuscitation.

ADVANCED LIFE SUPPORT

1. Attach and monitor ECG. Dysrhythmias should be treated in this setting when they appear to be the cause of hemodynamic instability. If time and patient condition allow, perform 12 Lead ECG, and FAX to E.D.

2. Eligibility Criteria for Thrombolytic Therapy:
   1. Clinical Criteria:
      1. Chest pain, pressure, aching, burning, tightness or heaviness with or without arm, jaw, neck, shoulder, or back radiation. Epigastric discomfort, indigestion, belching, or "heartburn". Nausea, vomiting, and/or diaphresis. Persistent dyspnea. Dizziness, lightheadedness, syncope, and/or weakness.
      2. Symptoms onset less than/equal to 12 hours prior.

   2. ECG Criteria: One or more of the following:
      1. > 1 mm ST segment elevation in > 2 anatomically contiguous limb leads.
      2. > 2 mm ST segment elevation in > 2 anatomically contiguous precordial leads.
      3. New LBBB
      4. None of the contraindications listed elsewhere (extensive list).
      5. Patient not in cardiogenic shock.