10. Chest Pain/Chest Discomfort (Non-Traumatic) - ACD

Question 1

Difficulty Speaking Between Breaths

Question 2

Changing Colour

Answer 2

• Ashen/gray
• Blue/cyanotic/purple
• Mottled

Question 3

First Law or Chest or Back Pain

Answer 3

“Hurts to breath” is not considered difficulty or abnormal breathing

Question 4

Second Law of Chest Pain

Answer 4

A little chest pain may be as bad as a lot

Question 5

Rule 1

Answer 5

Patients with a history of angioplasty, coronary artery stents, or bypass surgery are considered to have a history of heart attack or angina in the dispatch environment.

Question 6

Rule 2

Answer 6

When the complaint description involves both NON-TRAUMATIC chest pain/heart attack symptoms and breathing problems, choose the Chief Complaint Protocol that best fits the patient’s foremost symptom, with ECHO-level conditions taking precedence. (≥ 16, alert, no reported STROKE symptoms) Use the Aspiring Diagnostic & Instruction Tool on either protocol as appropriate.

Question 7

Rule 3

Answer 7

A patient having a heart attack may worsen at any time. Always advise to call back if condition worsens.

Question 8

Rule 4

Answer 8

A patient ≥ 35 with chest pain/discomfort is considered a heart attack patient until proven otherwise.

Question 9

Rule 5

Answer 9

If the caller asks whether the patient should be given their medication now, the EMD should only give instructions included in the protocol.

Question 10

Rule 6

Answer 10

Chest pain due to trauma (current or non-recent) should be handled on Protocol 30.

Question 11

Rule 7

Answer 11

If the complaint description involves both chest pain and STROKE symptoms, go to Protocol 10 but do not utilize the Aspiring Diagnostic & Instruction Tool

Question 12

Axiom 1

Answer 12

Patients with a history of angioplasty, coronary artery stents, or bypass surgery may not have actually had a heart attack (myocardial infarction). However, since these patients suffer from coronary artery disease, they have a greater risk of a heart attack than the general population.

Question 13

Axiom 2

Answer 13

True heart attacks are uncommon in females < 45 and males < 35

Question 14

Axiom 3

Answer 14

Medical Dispatch may consider heart attack (and an ALS CHARLIE response) in certain patients < 35 when the symptoms listed in Heart Attack Symptoms strongly suggest the possibility.

Question 15

Axiom 4

Answer 15

Automated external defibrillators (AEDs) might also be called “shock boxes” Other local names may be used.

Question 16

Axiom 5

Answer 16

Aspirin administration is contraindicated when chest pain is accompanied by STROKE symptoms due to the possibility of acute aortic dissection involving concurrent coronary and carotid artery damage.

Question 17

Heart Attack Symptoms (EMD may initially receive non-specific complaints in heart attack cases. Due to patient denial or caller confusion, the following symptoms may not be recognized as a heart attack)

Answer 17

• Aching pain
• Chest pain/discomfort (now gone)
• Constricting band
• Crushing discomfort
• Heaviness
• Pressure
• Numbness
• Tightness
  While these symptoms are most common in the chest, they may also (or only) be present in the arm, jaw, neck, or upper back. These symptoms should be considered equivalent to chest pain and handled on Protocol 10.

Question 18

Thrombolytic and PCI Therapy

Answer 18

Thrombolytic Therapy: Use of drugs such as tissue Plasminogen Activator (t-PA) and Streptokinase to break down blood clots
Percutaneous Coronary Intervention (PCI) Therapy: Invasive technique to reopen blocked arteries
Critical, time-dependent therapies for patients suffering from developing heart attack. EMD is a vital first link in the chain of survival for these patients, as early recognition and rapid treatment are essential.