UTSW/BioTel EMS TRAINING BULLETIN
September 2014

EMS TB 14-001 Management of Patients With Chest Pain   (PDF Here)

Purpose:

  1. To ensure that paramedics provide appropriate management to patients with chest pain or other symptoms that might indicate a patient is suffering from a STEMI or is having acute cardiac ischemia.
  2. To ensure that a timely 12-lead EKG is obtained, transmitted to BioTel and the receiving hospital, and is attached to the Electronic Prehospital Record (E-PCR).

 

Training Points:

  1. A 12 lead EKG shall ALWAYS be obtained when a patient complains of chest pain, pressure or discomfort.
  2. A 12-lead SHOULD be considered when a patient complains of symptoms other than chest pain, which may be an “anginal equivalent”, such as:
      1. Shortness of breath or difficulty breathing
      2. Epigastric pain
      3. Non-traumatic back, neck, jaw, or arm pain
      4. Diaphoresis
      5. Nausea/vomiting
      6. Extreme fatigue
      7. Shortness of breath
      8. Syncope or near syncope
      9. Palpitations
      10. A sense of “impending doom”
  1. An anginal equivalent occurs more frequently in the elderly population, diabetics, women, and those with cardiac risk factors. These complaints merit a 12 lead EKG.
  2. Prominent risk factors for STEMI or Acute Cardiac Syndrome (ACS) include a history of coronary artery disease, diabetes, HTN, high cholesterol, prominent smoking history, prior MI, cocaine &/or amphetamine use and prominent family history of MI or coronary artery disease.
  3. A 4-lead EKG does not suffice in place of a 12-lead EKG. A 4-lead only looks at a small portion of the heart and therefore a STEMI may be missed if only a 4-lead EKG is obtained.
  4. An EKG that is suggestive of a STEMI shall always be transmitted to BioTel AND the receiving hospital emergency department.
  5. STEMI activations will take place prior to hospital arrival in accordance with the particular STEMI Center’s hospital’s policy.
  6. All EKG’s shall be given to the receiving hospital emergency department staff and then electronically attached to the Electronic Prehospital Care Record. (E-PCR)