Acute Coronary Syndrome (with of without associated symptoms) Flashcards
Clinical Severity Prompts
Chest pain / discomfort - heavy, central/left/right and/or associated symptoms
Time - pain lasting longer than 5 minutes
History Prompts
Symptoms suggestive of myocardial ischaemia ⇒ PQRST to describe pain
Associated Symptoms
- nausea / vomiting
- sweating
- shortness of breath
- palpations
- lethargy / fatigue
Other
- relevant past history
- risk factors: familial diabetes, hyperlipidaemia, smoking, Aboriginal & Torres Strait Islander
- Medication history incuding ⇒ Sidenafil (Viagra)
- allergies
Remember for Chest Pain patient…
Commence NSW Chest Pain Pathway
Airway - Assessment
Assess patency
Airway - Intervention
Maintain airway patency
Breathing - Assessment
Respiratory rate & effort
SpO2
(Auscultation)
Breathing - Intervention
Assist ventilation if required
Apply O2 if SpO2 < 93%**
Circulation - Assessment
Skin temperature - touch
Pulse rate & rhythm
Capillary refill
Blood pressure
Cardiac Monitor
Electrocardiography
Circulation - Intervention
Aspirin 300mg (chew) (if not already given by Ambulance)
If pain present, give Glyceryl Trinitrate S/L 300-600mcg or GTN spray S/L (400-600mcg) if SBP > than 90mmHg ⇒ can be repeated every 5 minutes.
Monitor vital signs frequently
12 lead ECG (within 5 minutes of arrival to ED)
IV cannulation/pathology
If pain present, give IV Morphine 2.5mg increments every 5 minutes to a total of 10mg or IM Morphine 5-10mg (if IV access unavailable)
Disability - Intervention
AVPU/GCS + pupils → Monitor LOC frequently
Finger prick BGL
Measure and test
Pathology → Collect blood for FBC UEC and Troponin
Fluid input/output → FBC
Monitor pain score → If pain free after 30 min ⇒ 12-lead ECG
If pain returns at any time ⇒ 12-lead ECG
