Date of Issue: 07/01/2019



SUBJECT:Atraumatic Chest Pain/DiscomfortPURPOSE:To clearly establish the Department’s position on the clinical care and treatment of patients suffering from atraumatic chest pain.SCOPE: This clinical protocol applies to all agents of a department that receive Medical Direction through the Virtua Health MORE Program and shall be applicable to all personnel operating as an agent of Shamong EMS.Responsibility:All personnel from a department that receives Medical Direction through the Virtua Health MORE Program are the adhere to this protocol. The Medical Director or his/her designee(s) will be responsible for assuring compliance through direct observation, feedback and quality assurance reviews, which the assistance of the department’s management team. Unusual occurrences involving patient care will be reported to the NJSDOH-OEMS in compliance with N.J.A.C. 8:40-3.5.Procedure:Conduct scene size up, primary assessment and immediate lifesaving interventions. Have an AED nearby and ready.In patients exhibiting shortness of breath or hypoxia (SpO2 <94%), administer oxygen to improve respiratory symptoms or saturation to between 94-99%.Avoid exerting the patient and much as possible and place in a position unless necessitated by other factors. Ensure ALS has been dispatched. Consider transport to a receiving facility with emergency cardiac catheterization (PCI) capability. Minimize on scene time. Obtain baseline vital signs, SAMPLE and OPQRTS history, and conduct a secondary assessment. Attentive to contraindications to fibrinolytic therapy (recent bleeding, surgery, etc.) and cardiac compromise.If no contraindications are noted give up to 325mg of Aspirin (ASA) within 5 minutes of patient contact, orally (PO). USE ONLY THE ASPIRIN THAT IS PROVIDED BY YOUR DEPARTMENT.Administration of ASA:ASA should be given as soon as possible, once indicated, and prior to any dose of nitroglycerin.Take into consideration doses of non-enteric coated Aspirin that was taken in the last 24 hours. Have the patient thoroughly chew then swallow the ASA tablet(s), even if the tablet is not “chewable” ASA. A small sip of water may be given if the patient cannot chew well. Once patient is done chewing ASA, if indicated administrate sublingual nitroglycerin (NTG). MEDICATION HAS TO BE PRESCRIBED FOR AND SUPPLIED BY THE PATIENT.Administration of NTG:Assist with one tablet or spray under the tongue.Reassess chest discomfort using 1-10 pain scale and vital signs after 1-2 of each administration.Repeat one dose of NTG every 5 minutes until a maximum of three has been administered for any one episode.WHEN QUESTIONS OR CONCERNS ARISE, CONTACT MEDICAL CONTROLContraindications for ASA:Known hypersensitivity or allergy to ASA.325mg ASA taken in the past 24 hours.Bleeding or active bleeding disorderPregnancySuspicion of thoracic or AAAASA is expired.Contraindications of NTG:3 doses of NTG within a 15-minute period prior to or during this episode.Systolic BP <120Recent head injuryPhosphodiesterase (PDE) inhibitor use within 72 hours.Sometimes PDE inhibitor medications are known as erectile dysfunction medications. NTG is expired.Adverse Effects for ASA:AnaphylaxisAngioedemaNausea/VomitingBleedingStomach irritationAdverse Effects for NTG:HeadacheBradycardiaCardiovascular collapseFlushingLightheadednessHypotensionMethemoglobinemiaMandatory Documentation:Note dose(s) include doses prior to EMS arrival.Method of administrationIf ASA is administered in >5 minutes of patient contact explain why. ................
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