Chapter 15 - Cardiac Emergencies—Chest Pain, Stemi, ACS, CHF

Abstract

Chest pain is a common chief compliant that one will encounter in a prehospital setting, which can be due to cardiac emergencies. This chapter will review how to approach chest pain and cardiac emergencies in the prehospital setting. Key diagnoses that should be considered in chest pain patients will be reviewed, with a more focused description on how to interpret an EKG, acute coronary syndrome (ACS), and congestive heart failure (CHF). The first step to evaluating a chest pain patient is obtaining vital signs and preforming an appropriate physical exam of the heart and lungs. After examining the patient an EKG can then be obtained to gain more clinical information. The EKG findings can be used to diagnose an ST-segment elevation myocardial infarction (STEMI), or can help suggest other diagnoses. If the EKG does demonstrate a STEMI, it is imperative to know what medications can be given and what facility the patient should be brought to. Once a STEMI is ruled out, then it is important to correlate the EKG findings to the clinical presentation. If ACS or CHF are still considered in the clinical scenario, there are still medications that should be given and considered (i.e. aspirin, nitro, etc). In addition, if the patient is in respiratory distress from CHF, it is important to understand when and how to use noninvasive positive pressure ventilation (NPPV). Overall, it is important to know what treatments to give and where to transport patients with cardiac emergencies.