CHEST PAIN/CARDIAC

PRE-HOSPITAL PROTOCOL

Chest Pain / Cardiac Pre-Hospital Protocol

***Patient without intact/secure Airway, Breathing and Circulation should be
transported to the nearest receiving emergency facility

HISTORY SIGNS & SYMPTOMS DIFFERENTIAL

1
Age a  Chest Pain Trauma VS Medical
Medications  Location Angina VS M.I.
Viagra, Levitra, Cialis  Radiation Pericarditis
Past Medical History  Quality Pulmonary Embolism
 MI, Angina, Diabetes, Post  Severity Asthma/COPD
Menopausal, Cholecystectomy  Duration Pneumothorax
Allergies Location/Radiation of Pain Aortic Dissection or Aneurysm
 ASA, Morphine, Lidocaine Pale, Diaphoresis GI Pain
Recent physical exertion Shortness of Breath GI reflux or Hiatal Hernia
Palliation/Provocation Nausea, Vomiting, Dizziness Esophageal Spasm
Signs/symptoms time, quality, severity, Time of onset Chest Wall Injury of Pain
location and duration Overdose (Cocaine or Meth)
Prior to arrival treatment NOTE: Diabetics do not always
Smoker? exhibit pain
Cocaine or other stimulant use
Do they have a cardiologist?

TREATMENT PROTOCOL/STANDARDS
EMT PARAMEDIC

Manage the patient’s airway, breathing and circulation priorities. NOTE:

Obtain primary medical history and perform physical examination managing any priority injury/illness QUICKLY
Oxygen: 4LPM nasal cannula (unless patient’s condition warrants higher concentration, use appropriate delivery DETEMINE:
system)
Obtain and reassess vital signs every 5-10 minutes
Follow local protocol for general medical/cardiac patient care *If a STEMI is
present

Rapid 12-Lead ECG acquisition & transmission to medical control and/or receiving facility (if avail.) *If the patient
Assist with pateient’s prescribe Nitroglycerine 0.4 mg sublingual spray/table
has a cardiologist
Troponine Test
and his/her name

Establish IV and consider establishing a second IV if time permits (Do not delay treatment/transport establishing Transport
an IV) according to local
Consider IV fluids bolus if patient with hypotension
STEMI plan or
ASA 324 my PO (4 chewable baby aspirin are preferred if patient is able to chew and swallow) – unless known allergy
patient
destination
Rapid acquisition and interpretation of 12-Lead ECG protocol
Nitroglycerine [NTG]: Avoid NTG in any patient who has used Viagra or Levitra or Cialis due to potential severe
hypotension- Refer to local protocol regarding NTG Request
 0.4 mg sublingual repeat up to 3 times (titrated to pain and pain and maintaining a systolic BP > 90mm/Hg). transport ASAP
For continued pain
 Paralgan IV Referring to
Nausea/Vomiting (Follow nausea/vomiting protocol) nearest hospital
 Promethazine ASAP
1
 a
Primepran
Treat Hypotension shock.

FRAMSU: Health Care Provider – General Use