Page 207 - ATP-P 11th Ed

CHEST PAIN PROTOCOL

SPECIAL CONSIDERATIONS
1. This Protocol assumes no access to ACLS medications or monitoring/defibrilla-
tion equipment.
2. Since the ATP does not have access in the field to tests required to accurately
determine the etiology of chest pain, early and rapid evacuation should be con-
sidered if tactically feasible. High risk etiologies include myocardial infarction
(MI), unstable angina, pulmonary embolus, pericarditis, spontaneous pneumo- SECTION 2
thorax, and esophageal rupture.

Signs and Symptoms – Cardiac
1. The presence of one or more of the following risk factors increases the likelihood of coro-
nary artery disease: smoking, diabetes, hypertension, elevated cholesterol, obesity, family
history of MI at a young age, and patient age over 40.
2. The following are signs and symptoms suspicious for myocardial infarction as the etiol-
ogy for chest pain:
a. Substernal chest pain that may radiate to the left arm, neck, or jaw
b. Pain described as pressure or squeezing
c. Pain exacerbated with exertion and relieved with rest
d. Associated dyspnea, diaphoresis (sweating), nausea, lightheadedness, or syncope
e. Tachycardia, irregular heart rhythm, or severe bradycardia
f. Bilateral rales/crackles in the lungs on auscultation
g. Significant hypertension or hypotension
Management
1. Aspirin (ASA) 325mg PO (nonenteric coated) – chew to speed absorption.
2. IV access with saline lock. Administer 250–500mL normal saline boluses as needed to
correct hypotension with frequent reassessment.
3. Morphine sulfate 5mg IV initially, then 2mg q10–15min prn for pain unless hypo-
tension is present. Maintain a minimum BP of 90mmHg systolic (palpable radial pulse).
4. Oxygen with pulse oximetry monitoring
5. Avoid all exertion. Allow the patient to rest in a position of comfort. Frequently reassess
the patient including hemodynamic status.

196 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 197