Transcription of EMS Chest Pain / ACS Guidelines - American Heart Association
1 EMS Chest Pain / ACS Guidelines ACS Signs & Symptoms STEMI Criteria 12 Lead EMS ECG Criteria Chest pain- any non-traumatic pain Patients > 20 years old experiencing any between the jaw & umbilicus ST segment ACS signs & symptoms Chest pressure, discomfort or tightness elevation of 1 mm OR. Complaints of Heart racing or in 2 contiguous leads Any age patient with ACS signs &. palpitations symptoms AND a history of: Bradycardia with or without signs HTN Cardiac disease Syncope & symptoms of ACS Smoking Diabetes mellitus Weakness in patients > 45 years old Severe Obesity High Cholesterol New onset stroke symptoms Recent recreational drug use Difficulty breathing (without obvious cause asthma or CHF) When in Doubt, Obtain an ECG.
2 Minimize patient exertion Legend F F. F First Responder F. Apply Oxygen to maintain SPO2. F F B EMT-Basic B. > 94%. 324 mg Aspirin PO EMT- B B I I. Chewed, not swallowed Intermediate Obtain 12 Lead ECG within 10 P Paramedic P. B B. minutes of patient contact M Medical Control M. If STEMI Criteria met, activate CATH LAB, transmit ECG &. P immediately initiate transport P. to appropriate PCI capable hospital. Establish IV access at TKO rate or I I. saline lock Code STEMI Considerations: 1) Keep patient connected SBP > 110 mmHg to monitor & 12 lead mg nitroglycerin SL tablet or cables when brought into SL spray q 5 minutes until pain is P P If SBP falls < 110 mmHg in ED for physician gone or max 3 doses.
3 Maintain response to treatment: evaluation SBP > 110 mmHg Discontinue standing 2) If possible, remain on Pain unrelieved by Nitro: P. P nitroglycerin & P. EMS stretcher and Morphine 2-4mg slow IVP. analgesic treatments monitor in ED max 20mg P. 3) Prepare to be escorted OR. to CATH Lab on EMS Fentanyl 1mcg/kg q 15. stretcher and monitor to minutes max 200 mcg If C/P is thought to be stimulant expedite transfer of care induced: SBP < 110 mmHg to CATH LAB Diazepam slow F Shock position F. nurse/physician. IVP max 10mg 250ml NS bolus to achieve OR.
4 I SBP 110mmHg. Max 1 L NS, I P P. Midazolam slow monitoring breath sounds IVP max 5mg or IN max Morphine or Fentanyl analgesic 10mg M M. per medical control PEARLS: Females, diabetics and geriatric patients often have atypical signs/symptoms, or only generalized complaints Remember Erectile Dysfunction drugs are now being used to treat pulmonary hypertension Do not administer Nitroglycerin in any patient who has used Viagra (sildenafil) or Levitra (vardenafil) in the past 24 hours or Cialis (tadalafil) in the past 36 hours due to potential severe hypotension If possible, establish a second IV on STEMI patients DURING TRANSPORT ONLY.
