This section is limited to Adult patients.

First 10 minutes

• Recognition of potential for symptoms to be cardiac
• Vital signs
• O₂, monitor, IV
• 12 lead EKG
• Draw labs
• Physical examination/brief history
• Determine stable/unstable
• Review if patient is candidate for fibrinolytics

Immediate treatment

• Oxygen at 4 liters/min or more (Sats 90%)
• Aspirin 160-325 mg
• Nitroglycerin SL, Spray or IV
• Morphine IV if pain not relieved by nitroglycerin

Portable CXR (within 30 minutes)

1. EKG with STEMI or new LBBB then (if no contraindication)
• Beta blockers
• Clopidogrel (Plavix)
• Heparin (unfractionated or low molecular weight)
• If symptoms <12 hours then reperfusion (PCI or fibrinolytics)
• Door to fibrinolytic time goal <30 min
• Door to PCI goal <90 min
• Following admission, ACE-I or ARB within 24 hours of onset of symptoms
• Initiation of statin therapy ASAP
• Admit
2. EKG w/ ischemic changes then (if no contraindications)
• Beta blockers
• Nitroglycerin
• Clopidogrel (Plavix)
• Heparin (unfractionated or low molecular weight)
• Glycoprotein IIb/IIIa inhibitor
• Consider early cardiac catheterization
• ACE-I or ARB
• Statin therapy
• Admission
3. EKG normal or non-specific then (if no contraindications)
• Consider serial enzymes, admission, EKG monitoring and stress test

General Considerations

• Risk factor stratification based upon history must be utilized in one's clinical decision making
• Quality measures often recommend that any patient that is being admitted for chest pain at minimum be on both aspirin and a beta blocker until a full evaluation has occurred

Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.