UTSW/BioTel EMS TRAINING BULLETIN
September 2014
EMS TB 14-001 Management of Patients With Chest Pain (PDF Here)
Purpose:
- 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.
- 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:
- A 12 lead EKG shall ALWAYS be obtained when a patient complains of chest pain, pressure or discomfort.
- A 12-lead SHOULD be considered when a patient complains of symptoms other than chest pain, which may be an “anginal equivalent”, such as:
- Shortness of breath or difficulty breathing
- Epigastric pain
- Non-traumatic back, neck, jaw, or arm pain
- Diaphoresis
- Nausea/vomiting
- Extreme fatigue
- Shortness of breath
- Syncope or near syncope
- Palpitations
- A sense of “impending doom”
- 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.
- 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.
- 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.
- An EKG that is suggestive of a STEMI shall always be transmitted to BioTel AND the receiving hospital emergency department.
- STEMI activations will take place prior to hospital arrival in accordance with the particular STEMI Center’s hospital’s policy.
- 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)