Acute chest pain

ACS - acute coronary syndrome covers a range of conditions as unstable angina ST-segment elevation MI ( STEMI ) Non-ST segment elevation MI ( NSTEMI )

Features suggesting ACS-pain in chest & or other areas ( arms ,back or jaw ) lasting longer than 15 mins chest pain associated with ○ nausea and vomiting ○ marked sweating ○ breathlessness or particularly a combination of these chest pain with HD instability new onset chest pain or abrupt deterioration in previously stable angina with recurrent chest pain occurring frequently and with little or no exertion and with episodes often lasting > than 15 mins

Take into account-characteristic of pain history of chest pain any CV risk factors h/o IHD and any previous treatment previous investigation for chest pain

ACS suspected- immediate management pain relief ( GTN or an IV opioid ) 300 mg aspirin ( r/o allergy ) give written info to hospital if given Do not offer other antiplatelets if allergy to aspirin in primary care resting 12-lead ECG pulse oximetry Only offer oxygen if level < 94 % with no risk of hypercapnic resp failure aim for 94-98 % For COPD patients aim for 88-92 %

Check -haemodynamic status signs...