Cardiac Chest Pain

Question 1

Primary Survey

Answer 1

• Confirm there are no D-Spine precautions
• Assess lvl of consciousness (AVPU) scale
• Assess and manage ABC’s as required
• Expose and examine chest
  1. Palpate and inspect for trauma
  2. Inspect for signs of previous cardiovascular intervention (surgery scar, pacemaker, internal defibrillator, etc.)
• Complete RBS
• Apply O2 (Target SPO2 94%)
• Consider administering ASA (as per protocol)
• Consider the patients position based on comfort/signs & symptoms of shock

Question 2

Decision Point

Answer 2

All patients exhibiting cardiac chest pain are unstable

Question 3

Load and Transport

Answer 3

The Chest Pain Protocol will outline when to initiate transport

Question 4

Critical History

Answer 4

• Compare current chest pain to previous episodes
• Cardiac history (previous MI, angina, surgeries, CHF, etc.)
• Use of nitroglycerin, ASA or other cardiac or respiratory medications
• Consider risk factors (HTN, diabetes, family Hx, smoker, etc.)
• Look for signs of cardiac conditions (pitting pedal edema, pulmonary edema, SOB, irregular HR, etc.)
• Patient history
• SAMPLE and OPQRRRST

Question 5

Vital Signs

Answer 5

• Baseline vitals taken on scene if nitroglycerin is indicated
• If nitroglycerin is not indicated, complete baseline vitals enroute to hospital
• Complete vital signs q5 for unstable patients
• Complete vital signs q15 for stable patients

Question 6

Hospital Notification and Head to Toe/Functional Inquiry

Answer 6

Completed enroute to hospital

Question 7

Protocol(s)

Answer 7

• Cardiac chest pain protocol (if indicated)
• Pain management protocol (if indicated)

Question 8

Treatment

Answer 8

• Refer to Chest pain protocol guidelines for guiding principles and other considerations
• Refer to drug monograph(s) for indications, contraindications, and dosages of medications
• Ensure pain scale and blood pressure are taken prior to any nitroglycerin administration
• Consider Entonox if ASA/NITRO contraindicated