Protocol 2-220 - Chest Pain / Suspected Cardiac Event

CMH EMS & MIH Protocols

EMD:

• MPDS Aspirin Diagnostic: EMDs are NOT authorized to suggest self-administration of Aspirin.

EMR:

• Calm and reassure patient. Ensure patient does not exert themselves.
• Oxygen to maintain SpO2 between 94-99%.
• Apply Cardiac Monitor limb leads.
• STEMI verified by ALS or physician:
  • Consider Combo Pads anterior / posterior
  • Remove clothing and place patient in gown.

EMT:

• Ensure completion of applicable items above.
• Obtain 12-Lead ECG within 10 minutes of patient contact.
• If ALS is unavailable, transmit to closest ER or CMH ER and contact ER by phone to obtain interpretation.

• Adult:	Pediatric:
  No trauma: Aspirin 324 mg (4 chewable tablets - 81 mg each) within 5 minutes of patient contact. Unless contraindicated, healthcare-provider Aspirin administration must be completed and documented in ePCR for all cardiac chest pain patients.	NA.

• Consider assisting ALS with Capnography.
• STEMI verified by ALS or physician:
  • Transport according to Protocol 2-220-50 - STEMI Destination Matrix.

AEMT:

• Ensure completion of applicable items above.
• IV NS/LR in AC (left is preferred) with pigtail extension with 18 ga or greater. Consider second 18 ga IV in right AC.

• Adult:	Pediatric:
  No trauma and SBP greater than 100: Nitroglycerin 0.4 mg SL (1 spray or 1 tablet). Every 5 min until no Pain or SBP less than 90. Ensure IV access prior to Nitroglycerin administration. Contraindicated if phosphodiesterase inhibitor (i.e., Viagra) within 48 hours.	NA.

RN:

• Ensure completion of all applicable items above.
• Consider IO NS/LR.
• Interpret 12-Lead ECG within 10 minutes of patient contact. Refer to Protocol 8-108-01 - ECG Interpretation Guide.
  • 15-Lead ECG indicated when: normal ECG, inferior MI, ST depression in V-leads.
  • Cath Lab Activation:
    • Contact ER to activate Cath Lab as early as possible via encrypted radio (CMH ER) or CMH ER Charge Nurse at 417-328-6923.
    • Transmit ECG to receiving facility ER (if possible).
• Consider serial 12-Lead ECGs.
• Pulmonary edema: Refer to Protocol 2-726 - Pulmonary Edema.

• Adult:

  Pediatric:

  No trauma: Right-sided MI (ST elevation in V4R): LR 1-2 L followed by Nitroglycerin 5+ mcg/min IV/IO. SBP less than 100: Consider Nitroglycerin 10+ mcg/min IV/IO titrated to blood pressure and Pain. Continued discomfort or Pain: Consider Fentanyl 50-100 mcg every 5-20 min (max 300 mcg) IV/IO/IN. Over 65 yr old: 0.5-2 mcg/kg. Click "calculate" to get dose. Consider contacting MEDICAL CONTROL for Heparin 4,000 u.

  NA.

• Nausea or vomiting: Refer to Protocol 2-990 - Vomiting.

Medic:

• Ensure completion of all applicable items above.

CP:

• Ensure completion of all applicable items above.

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