Discomfort / Pain of Suspected Cardiac Origin

BLS

• Ensure patent airway

• O2 saturation PRN

• Use supplemental O2 to maintain saturation at 94-98%

• O2 and/or ventilate PRN

• Minimize patient exertion, including walking, when possible

• If SBP greater than or equal to 100 mmHg, may assist patient to self-medicate own prescribed NTG* SL

  • Maximum 3 doses, including those the patient has taken

  • *NTG is contraindicated in patients who have taken erectile dysfunction medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) within 48 hours; and pulmonary hypertension medications such as sildenafil (Revatio), and epoprostenol sodium (Flolan and Veletri)

• May assist with placement of 12-lead ECG leads

• May assist patient to self-medicate own prescribed aspirin up to a max dose of 325 mg

ALS

• Monitor/ECG

• IV

• Obtain 12-lead ECG

• Repeat 12-lead ECG after arrhythmia conversion or any change in patient condition*

  • *Do not delay transport for a repeat 12-lead ECG

• If STEMI suspected, immediately notify BH, transmit 12-lead ECG to appropriate STEMI receiving center and transport*

  • *Immediately transmit 12-lead ECG to receiving transport for suspected STEMI patients regardless of patient presentation

• Report LBBB, RBBB or poor-quality ECG

• Aspirin 324 mg chewable PO*/**

  • *Administer aspirin even if discomfort/pain has resolved. If aspirin is not given, document the reason

  • **Aspirin may be withheld if an equivalent dose has been administered by a healthcare professional

ALS - If SBP greater than or equal to 100 mmHg

• NTG* 0.4mg SL, MR q3-5 min

  • *NTG is contraindicated in patients who have taken erectile dysfunction medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) within 48 hours; and pulmonary hypertension medications such as sildenafil (Revatio), and epoprostenol sodium (Flolan and Veletri)

• Treat pain with opioids per Pain Management Protocol

ALS - Discomfort/pain of suspected cardiac origin with associated shock

250 mL fluid bolus IV/IO with no rales, MR to maintain SBP greater than or equal to 90 mmHg

ALS - If BP refractory to second fluid bolus

Push-dose epinephrine 1:100,000 (0.01 mg/mL) 1 mL IV/IO, MR q3 min, titrate to SBP greater than or equal to 90 mmHg

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Push-dose epinephrine mixing instructions:

1. Remove 1 mL normal saline (NS) from the 10 mL NS syringe

2. Add 1 mL epinephrine 1:10,000 (0.1 mg/mL) to 9 mL NS syringe

The mixture now has 10 mL of epinephrine at 0.01 mg/mL (10 mcg/mL) concentration.