Protocol - Discomfort/pain Of Suspected Cardiac Origin - Adult 2008-2009

Front 1

BLS (all patients)

Back 1

- Ensure patent airway
- O2 and/or ventilate prn
- Do not allow patient to walk
- If systolic BP ≥ 100, may assist patient to self medicate own prescribed medication ONE TIME ONLY (maximum 3 doses, including those patient has taken). Base Hospital contact required prior to any repeat dose.

Front 2

ALS (all patients)

Back 2

- Monitor EKG/O2 saturation prn
- IV SO adjust prn
- Obtain 12 Lead EKG. If STEMI, notify base immediately and transport to appropriate STEMI center.

- ASA 162 mg chewable PO SO

Front 3

ALS - If systolic BP ≥ 100

Back 3

- NTG 0.4 mg SL SO. MR q 3-5" SO
- NTG ointment 1" SO
- If NTG x 3 ineffective or contraindicated:
- MS 2-4 mg IVP SO. MR to max of 10 mg SO. MR to max of 20 mg BHO

Front 4

ALS - If systolic BP < 100

Back 4

- NTG 0.4 mg SL BHO. MR BHPO
- MS 2-4 mg IVP BHO. MR to max of 20 mg BHO

Front 5

ALS - Discomfort/Pain of ? Cardiac Origin with Associated Shock

Back 5

- IV 250 ml fluid bolus with clear lungs SO. MR to maintain systolic BP ≥ 90

If BP refractory to fluid boluses:
- Dopamine 400 mg / 250 ml @ 10-40 mcg/kg/min IV drip. Titrate systolic BP ≥ 90 BHO

Front 6

Note #1

Back 6

If discomfort/pain is relieved prior to arrival, continue treatment with NTG ointment and ASA. ASA should be given regardless of prior daily dose(s).

Front 7

Note #2

Back 7

If any patient has taken a sexual enhancement medication such as Viagra, Cialis, Levitra within 48 hours, NTG is contraindicated.