EMT- Basic
Treatment Protocol
6202
Chest Pain/Discomfort
Acute Coronary Syndrome (ACS)
A.
Page 1 of 4
Indications for this protocol include one or more of the following:
1.
The classic symptom associated with an Acute Coronary Syndrome (ACS) is
chest discomfort, but symptoms may also include discomfort in other areas on
the upper body, shortness of breath, sweating, (diaphoresis), nausea,
vomiting, and dizziness. Many patients complain of substernal chest pain,
pressure or discomfort unrelated to an injury or other readily identifiable cause.
2.
History of previous ACS/AMI with recurrence of similar symptoms.
3.
Any patient with a history of cardiac problems who experiences
lightheadedness or syncope.
4.
Patients of any age with suspected cocaine abuse and chest pain.
5.
Atypical or unusual symptoms (other than chest discomfort) are more
common in women, the elderly and Diabetic patients.
B.
If patient has no history of allergy to aspirin and has no signs of active bleeding
(i.e., bleeding gums, bloody or tarry stools, etc.), then administer 4 (four) 81 mg
chewable aspirin orally (324 mg total).
C.
BLS: Perform Medical Assessment & Management Procedures Protocol 6201.
Request ALS Back-Up if assessment leads you to continue with this protocol.
1.
D.
Obtain 12 lead EKG (If available) and transmit copy or computer
interpretation to Medical Command and to the receiving facility (BLS 12Lead decision algorithm below).
If blood pressure > 100 mm/Hg systolic and patient has not taken Viagra or
Levitra within last 24 hours (or Cialis within the last 72 hours), then contact
Medical Command for the following orders:
1.
Administer nitroglycerine 0.4 mg (1/150 gr) SL
2.
Repeat every 5 minutes until pain is relieved
or until 3 (three) doses administered.
West Virginia Office of Emergency Medical Services - State EMT-Basic Protocols
6202 Chest Pain Final 09/01/96 Revised 12/05 Revised 08/06, Revised 08/072013
EMT-Basic
Treatment Protocol
6202
Chest Pain/Discomfort
Acute Coronary Syndrome (ACS)
E.
Page 2 of 4
3.
Recheck blood pressure between each nitroglycerine
dose administered. If blood pressure falls below 100
systolic, discontinue dosing and contact Medical
Command Physician to discuss further treatment.
4.
Contact Medical Command to determine mode of
transport (ground vs. air) and appropriate destination.
If blood pressure < 100 systolic and patient has not taken nitroglycerine within
past 30 minutes, this is a potential life threatening emergency.
1.
Position with head elevated no more than 15 degrees.
2.
Do not administer Nitroglycerine (NTG).
3.
Transport – continue treatment en route.
F.
Special Note: If patient has respiratory distress with fluid in their lungs as
suggested by crackling or bubbly lung sounds, and/or frothy sputum and have
inadequate respirations, they should have their ventilation assisted with 100%
oxygen, positive pressure Bag Valve Mask (BVM), even if patient remains
conscious. Also evaluate the patient for possible treatment with Continuous
Positive Airway Pressure per CPAP Protocol 8301 if agency has optional
CPAP equipment and contact Medical Command.
G.
If transport time permits, complete AHA Fibrinolytic Checklist (see below).
West Virginia Office of Emergency Medical Services - State EMT-Basic Protocols
6202 Chest Pain Final 09/01/96 Revised 12/05 Revised 08/06, Revised 08/072013
EMT-Basic
Treatment Protocol
6202
Chest Pain/Discomfort
Acute Coronary Syndrome (ACS)
H.
Page 3 of 4
BLS 12-Lead Decision Algorithm
Patient experiencing Chest Pain or other
symptom(s) consistent with Acute Coronary
Syndromes [as outlined in # A. above]
Is 12-Lead EKG available?
Yes
Perform 12-Lead EKG and Transmit
EKG or Interpretation to Medical
Command Center and receiving facility.
(Pre-treatment 12-Lead EKG Preferred.)
Inability, or not performing an ECG
prior to arrival to hospital must be
documented.
Continue with treatment as per Protocol 6202
West Virginia Office of Emergency Medical Services - State EMT-Basic Protocols
6202 Chest Pain Final 09/01/96 Revised 12/05 Revised 08/06, Revised 08/072013
No
EMT-Basic
Treatment Protocol
6202
Chest Pain/Discomfort
Acute Coronary Syndrome (ACS)
Page 4 of 4
Cardiac Thrombolytic Therapy Screening: Name of person filling out form:
Patient Name:_
Duration of symptoms:_
Age
/_
hrs./mins.
1.
S-T segment elevated or depressed at least 0.1 mv?
2.
History of bleeding problems, i.e. nose, gums, etc?
3.
History of bleeding ulcers?
4.
History of bleeding hemorrhoids?
5.
Any surgery in last 6 months?
6.
Any dental procedures in last 6 months?
7.
History of stroke (including family)?
8.
History of sudden/temporary weakness/numbness of
face or extremities, dizziness or unsteadiness?
9.
History of difficulty with speech or visions?
10.
History of headaches or mental status changes?
11.
Any recent falls or injuries?
12.
History of high blood pressure?
13.
History of diabetes?
14.
History of hemorrhagic retinopathy?
15.
Pregnant?
16.
Receiving oral anticoagulants?
17.
CPR performed recently?
18.
IM injections recently?
19.
Known cardiac arrhythmias?
20.
Liver dysfunctions?
West Virginia Office of Emergency Medical Services - State EMT-Basic Protocols
6202 Chest Pain Final 09/01/96 Revised 12/05 Revised 08/06, Revised 08/072013
Yes
No