Clinical Findings

Neuro: Anxiety, restlessness, dizziness, light-headedness, syncope, possible sense of impending doom.

Resp: SOB, tachypnea, abnormal lung sounds.

CV: Tachycardia or bradycardia, signs of congestive heart failure.

Skin: Coolness, pallor, cyanosis, diaphoresis.

MS: Substernal pain, weakness, fatigue, sensation of chest heaviness or chest tightness.

GI/GU: Nausea and vomiting.

Collaborative Management

• Immediately activate RRT.
• Administer oxygen titrated to SpO₂ >93%.
• Monitor VS closely as management modalities may cause hypotension and respiratory depression; HA can result from nitroglycerin administration.
• Perform focused pain assessment using OPQRST format.
• Obtain STAT 12-lead and continuous cardiac monitoring.
  Depressed ST segment or flat or inverted T waves suggest ischemia; ST elevations suggest acute injury. Be alert for cardiac arrhythmias d/t ischemia or infarction.
• Identify potential noncardiac causes of CP (e.g., gastric reflux, bronchitis).
• Inquire about recreational drug use (e.g., cocaine use can cause CP).
• Obtain and monitor labs as ordered (e.g., serial troponin and CK/CK-MB).
• Evaluate BUN and creatinine in preparation of PCI (contrast dye is nephrotoxic).
• Other labs may include CBC, INR, lipase, WBC, D-dimer, A1c, lipid panel.
• Administer or assist with STAT medication as ordered: