Chest Pain

1. Follow General Medical Protocol.

2. Mandatory interventions:

a. Cardiac monitoring

b. Oxygen only if SpO2 is less than 94% (target 90-98%)

c. IV access

3. Obtain 12 lead EKG.   If EKG shows indication of acute MI or dysrhythmia notify medical facility declaring a “STEMI alert”, transmit 12-lead EKG, and transport emergently. Monitor rhythm closely for any changes. Repeat 12-lead EKG as needed such as reoccurrence of pain after improvement.

4. Administer ASPIRIN up to 324 mg (if the pt has recently taken ASPIRIN consider that in the dose) orally and have patient chew before swallowing. (Ask about aspirin allergy prior to treatment).

5. Administer NITROGLYCERIN 0.4 mg 1 spray/tablet SL. May repeat every 5 minutes (maximum 3 doses). DO NOT administer if SBP < 90 OR if taking erectile dysfunction within previous 24 hrs (Viagra/sildenafil, Levitra/vardenafil) or within 48 hrs (Cialis/tadalafil). IV access SHOULD be in place prior to administration of nitroglycerin.

6. If nitroglycerin relieves the chest pain, apply NITROGLYCERIN PASTE 2% 1” to the anterior chest wall. If at any time during transport the patient becomes hypotensive, remove paste.

7. If pain continues despite nitrate therapy, administer FENTANYL 50 - 100 mcg IV every 5 – 10 minutes as needed.

a. Option: MORPHINE 2 – 5 mg IV every 5 – 10 minutes as needed.