Cardiopulmonary Emergencies
Cardiac Emergencies
Acute Coronary Syndromes (Unstable Angina and Acute Myocardial Infarction)
Signs and Symptoms
1. Chest pain that is often described as pressure, heaviness, tightness, or crushing or squeezing sensation and located in the center of the chest. The pain may be poorly localized or of a sharp, stabbing nature. It may radiate into the neck, jaw, or shoulders or down the inner aspect of the arms (left more frequent than right). Sometimes there is only mild chest pain, a burning sensation in the lower chest or upper abdomen, or a feeling of indigestion.
2. Diaphoresis, eructation, nausea, vomiting, anxiety, or dyspnea may be present.
3. Pain is often preceded or exacerbated by physical exertion.
Treatment
1. The patient should discontinue all exertion.
2. Administer oxygen 2 to 4 L/min by nasal cannula if the patient appears cyanotic or has respiratory distress.
3. Administer aspirin 325 mg PO if the patient is not allergic and has no history of significant bleeding.
4. If pain continues and the patient is judged to have normal blood pressure, administer nitroglycerin 0.4 mg sublingually (the patient should be lying down before nitrate administration). If pain persists, repeat this dose every 5 minutes for three doses. Nitrates should be withheld if the patient is suspected of being hypotensive (systolic blood pressure lower than 90 mm Hg). In the absence of a blood pressure cuff, hypotension can be recognized by the inability to palpate a strong radial pulse in the wrist or dorsalis pedis pulse in the foot.
5. If no allergy or bleeding predisposition, give clopidogrel 300 mg PO.
6. Evacuate the patient immediately to the closest medical facility with the patient exerting as little as possible.
7. Notify the emergency department regarding your estimated time of arrival as soon as possible to facilitate their readiness.
