Phase 1
Upright, clutching chest; anxious; “It’s tight… can’t catch my breath”; cool/pale/diaphoretic; rapid shallow breathing.
How is patient transported?
Stretcher with monitoring to medical unit or directly to EMS if STEMI suspected; do not allow ambulation.
Pressure, nausea, sense of doom; radiation to left arm; diaphoresis
What concerns does this raise?
•Acute coronary syndrome (ACS)
•possible STEMI; time sensitive emergency
BP 182/98, HR 115, SpO₂ 91% RA, T 98.1°F, EKG ST elevation, pain 10/10; patient requests sandwich and juice
What monitoring is required?
•Continuous cardiac monitoring
•serial vitals
•repeat ECGs
•SpO₂.
EMS arrives
SBAR?
S: STEMI suspected; chest pain 10/10; ST elevation on ECG.
B: Onset 1930; diaphoretic/dyspneic; HTN/tachycardic; SpO₂ 91% RA.
A: After O₂ and aspirin, remains symptomatic; hemodynamically stable; continuous monitoring.
R: Immediate transport to PCI-capable facility; continue monitoring and protocol en route.
Upright, clutching chest; anxious; “It’s tight… can’t catch my breath”; cool/pale/diaphoretic; rapid shallow breathing.
How does nursing establish medical control?
•Team Lead directs ABCs •requests immediate vitals •IV access •ekg within 10 minutes •oxygen as indicated
Pressure, nausea, sense of doom; radiation to left arm; diaphoresis
What condition must be assumed until ruled out?
•Myocardial infarction
BP 182/98, HR 115, SpO₂ 91% RA, T 98.1°F, EKG ST elevation, pain 10/10; patient requests sandwich and juice
What Medications are given?
What vital sign must be measured prior to medications given?
•Chewable aspirin (162–325 mg) unless contraindicated•nitroglycerin if SBP >90–100 and no PDE5 •consider analgesia per provider
•Blood pressure (prior to nitroglycerin)
EMS arrives
What information must be communicated during handoff?
•Onset/time •symptoms •risk factors •initial vitals •ECG with ST elevation •meds given (aspirin/nitro) with times/doses •response •current status •custody considerations
Upright, clutching chest; anxious; “It’s tight… can’t catch my breath”; cool/pale/diaphoretic; rapid shallow breathing.
What are your immediate assessment priorities?
•ABCs •pain assessment (OPQRST) •vitals •SpO₂ •12lead ECG •IV access •allergy/meds history (aspirin/nitro use)
Pressure, nausea, sense of doom; radiation to left arm; diaphoresis
What focused assessment will you perform?
•OPQRST •cardiac risk factors •meds (including PDE5 inhibitors) •allergies •prior events •focused lung/heart exam
BP 182/98, HR 115, SpO₂ 91% RA, T 98.1°F, EKG ST elevation, pain 10/10; patient requests sandwich and juice
What interventions are initiated immediately based on vital signs?
•Activate EMS •administer oxygen to reach SpO₂ ≥94% •obtain IV access •give aspirin if not contraindicated •pain management per protocol •prepare for nitroglycerin if SBP adequate and no PDE5 use
EMS arrives
What documentation is required?
•Pain assessments •ECG strips attached •vitals trends •meds with times/doses •oxygen therapy •provider notifications •EMS activation •SBAR content •chain-of-custody
Upright, clutching chest; anxious; “It’s tight… can’t catch my breath”; cool/pale/diaphoretic; rapid shallow breathing.
What must occur before medical care begins?
Scene safety
Pressure, nausea, sense of doom; radiation to left arm; diaphoresis
Must have focused questions:
•Onset/time •provocation •quality •radiation severity (0–10) •timing •prior episodes •meds taken today •use of ED/EMS previously
BP 182/98, HR 115, SpO₂ 91% RA, T 98.1°F, EKG ST elevation, pain 10/10; patient requests sandwich and juice
What level/route of oxygen therapy is given if any?
What dietary orders is the patient placed on?
•Nasal cannula 2–4 L/min to target SpO₂ ≥94%.
• NPO due to potential ACS and procedures