Chest Pain

1. Follow General Medical Protocol.

2. Mandatory interventions:

a. Cardiac monitoring

b. Oxygen

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 325 mg 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 erectile dysfunction medications taken within previous 8 hours. 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.