ACS
Chest pain / suspected heart attack
CCMS-MED-SOP-001 §9
Pressure, squeezing, tightness, crushing — chest, arms, neck, jaw, back, epigastrium. Women, diabetics, and the elderly more often present with dyspnea, nausea, or fatigue. Believe them.
Call 911 now. Do not debate this.
Give location, problem, and send a runner to meet EMS at the watched entry.
- 1
911. Sit or lie in a position of comfort. Loosen a tight collar. Do not walk them across campus 'to get some air.'
- 2
Aspirin 162–325 mg chewed if the adult is alert, can swallow, has no known aspirin/NSAID anaphylaxis, and has not been told by a physician to avoid aspirin.
- 3
Oxygen only if dyspneic, hypoxic, or in obvious distress. Routine high-flow O2 is not the current habit.
- 4
AED nearby. If they arrest, you already know the drill.
Do not
- Do not give ibuprofen or other NSAIDs for suspected ACS.
- Tums is not a diagnostic test. In a middle-aged diaphoretic adult you have not decided this is reflux.
- Do not stack extra antiplatelet if the story is tearing pain to the back with pulse deficit — flag dissection to dispatch, still activate EMS.
- Normal vital signs do not exclude ACS. Reproducible chest-wall tenderness lowers probability but does not zero it out.
- If a clinician is present and the patient has their own nitro: assisting is reasonable if SBP is adequate and they are not on PDE-5 inhibitors. You do not stock nitro.
This field guide does not replace 911, a medical director, or licensed clinical judgment. It does not authorize anyone to practice beyond license and current training.
Start over