Chest Pain (Non Traumatic) and
Acute Coronary Syndrome
General Adult Assessment
Continue Assessment
Go to General Adult Assessment
12 lead ECG within 5 minutes
of patient contact
Non-diagnostic
12-Lead ECG
STEMI
Refer to
STEMI(Suspected)
Continue Assessment
Go to STEMI
Vascular Access
Continue Assessment
Go to Vascular Access
Oxygen
Keep O₂ ≥94%
ASPRIN
324mg PO
NITROGLYCERIN
Assist pt with own NTG as
prescribed; may repeat X2
0.4mg SL;
May repeat q 5min X2
Nitroglycerin is contraindicated in any patient
with hypotension, bradycardia, tachycardia
(HR>100bpm) in the absence of heart failure,
evidence of a right ventricular infarction, and use
of erectile dysfunction medications within the last
48 hours. Caution is advised in patients with
Inferior Wall STEMI and a right-sided ECG should
be performed to evaluate RV infarction.
Refer to Arrhythmia and Shock Protocols as
needed
Pain Management for
continued pain
Continue Assessment
Go to Pain Management
Consider anti-emetic for
nausea/vomiting:
ONDANSETRON
4.0mg ODT/IM/IV/OI
or
METOCLOPRAMIDE
10mg slow IV bolus over 1-2
minutes or IM
or
PROCHLORPERAZINE
Up to 10mg IV/IM/IO
Transport to hospital of
patient’s choice