HomeMy WebLinkAboutSOG 203.01D Reviewed 5-2015 Chest PainI. Goal
The goal of this policy is to define the standard of care for any patient presenting with
chest pain or suspected cardiac complications.
il. Protocol
A. Institute protocol "203.01A" for all patients.
B. 02 by non-rebreather (15 1/min)
C. Obtain baseline vitals, utilize pulse oxemitry and obtain glucose reading. Repeat
vitals every 5-15 min.
D. Position of comfort for the patient.
E. Baby Aspirin 162 ing PO (2 pills ag Sl ing each). Aspirin is to be withheld
(NOT administered) IF:
1. Patient suffers from active gastrointestinal bleeding
2. Patient is allergic to aspirin
3. Patient has already taken 324 mg aspirin today
F. Nitroglycerin *ONLY IF:
1. Patient is awake/alert AND
2. Patient is on prescribed NTG AND
3. SBP > 1.00 mmHg
`May repeat NTG every 5 minutes until relief of symptoms or max 3 (doses.
En orseme ts:
Darioush Kavaspour, MD
Medical Director BEMS/BFRS
- 12
Date Signed
G. Contraindications:
1.
Max Dose (3 sprays)
2.
Systolic BP of 100 mmHg
3.
Hypotension
4.
Children under 12 yrs
5.
Use of Erectile Dysfunction drugs within 48 hours
W. Notes
A. Nitroglycerin
(NTG) Administration
1.
Recheck the BP before administering each dose of NTG.
2.
Do not administer NTG if systolic BP drops below 100 mmHg.
3.
Patients who have not had NTG before, frequently have profound
hypotension and bradycardia in response to the medication;
whereas the patient who routinely takes NTG develops tolerance to
it and has little systemic reaction to the medication.
4.
Should the patient develop hypotension, place the patient in
Trendelenburg position. Positioning will usually resolve the
hypotension in a few minutes.
5.
If the patient has taken Viagra®, or Levitra® in the past 24 hours,
or Cialis® within the past 48 hours, withhold (DO NOT
ADMINISTER) NTG. The combination of ViagraO, Cialis®, or
Levitra® and NTG can cause severe hypotension.
B. Nitroglycerin
1.
Class: Vascular smooth muscle relaxant
2. Action: Systemic vasodilator which decreases myocardial
workload and oxygen consumption.
3. Indication:
a. Angina Pectoris
b. Myocardiallnfarction
4. Contraindication:
a. Max Dose (3 sprays)
b. Systolic BP of 100 mmHg
C. Hypotension
d. Children under 12 yrs
e. Use of Erectile Dysfunction drugs within 48 hours
5. Side effects:
a. Hypotension
b. Rarely brief asystole
C. Headache and facial flushing
d. Dizziness
e. Decreased LOC
b. Dose: 0.4mg may repeat every 3-5 minutes or and blood pressure
7. Route: Sublingual- spray or tablet
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Medical Director's Initials Date
SOG 203.01D - Chest Pain (Suspected Cardiac Complications) Page 2 of 3
C. Aspirin
1, Class: Anti -Platelet
2. Action: Aspirin inhibits platelet aggregation, blocks pain impulses
in the CNS, and dilates peripheral vessels.
3. Indication:
a. Angina Pectoris
b. Myocardial Infarction
4. Contraindication:
a. Allergy or hypersensitivity to salicylates (aspirin,
wintergreen)
b. GI Bleeding
C. Active ulcer disease
d. Hemorrhagic stroke
e. Bleeding disorders
f. Not to be used in pregnant women
S. Side effects:
a. Heartburn
b. Nausea
C. Upset stomach
6. Dose: 2 Chewable tablets ("Baby Aspirin") S 1 m each for a total
dose of 324mg per day
7. Route: Oral
Medical Director -s InitialsU� /< .
Date
SO 203.07D -» Chest Pain (Suspected Cardiac Complications) Page 3 of 3