CARDIAC EMERGENCIES / CHEST PAIN

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.

FIRST RESPONDER PRE-HOSPITAL MANAGEMENT

1. Initial Management - Assess airway, breathing and circulation and manage as indicated.
2. Transport the patient to an appropriate medical facility.
3. Focused H&P - History, physical exam, vital signs.
a. If suspected ACS chest pain, administer ASPIRIN 325 mg PO.

BASIC PRE-HOSPITAL MANAGEMENT

b. If applicable, contact ONLINE Medical Control for administration of the patient's own NITROGLYCERIN every 3-5 minutes X 3, if BP > 100 systolic, HR > 60, and <140.
c. Cardiac monitoring, and obtain a 12 - lead EKG if possible for documentation.
d. Obtain history including fibrinolytic candidate screen.

INTERMEDIATE PRE-HOSPITAL MANAGEMENT

4. En route, initiate an IV of an isotonic solution at a TKO rate and consider second IV if time permits.
5. If patient does not have nitroglycerin and is still in pain, and BP > 100 systolic, HR > 60, and <140, consider NITROGLYCERIN [0.4 mg SL] every 3-5 minutes to a maximum of three doses, if IV initiated. If transport is prolonged, contact Medical Control for additional Nitroglycerin administration.
6. Contact Medical Control for the administration of MORPHINE SULFATE, [2 - 10 mg] in 1-2 mg increments, slow IVP. Morphine should be administered slowly and incrementally to avoid nausea and hypotension.  Also consider Use of Fentanyl, 25-50 mcg IVP, also with online Medical Control.

PARAMEDIC PRE-HOSPITAL MANAGEMENT
           
7. Follow Pain Management Protocols.

8.Transmit EKG to Medical Control if possible.

9. On-line medical control orders must be recieved before Air-Evac from field.