Pre-hospital management

If a patient with chest pain symptoms suggestive of possible acute coronary syndrome makes contact with primary care then

• they should be advised to ring "999" so that the presenting symptom can be assessed immediately in a secondary care setting.

If a patient with possible acute coronary syndrome presents in primary care then:

• organise immediate ambulance transport to secondary care for assessment
• whilst awaiting transport to hospital then:
  • take an ECG - an ECG may be diagnostic
  • if possible the patient should be attached to a cardiac monitor and a defibrillator should be to hand
  • high-flow oxygen should be given if required, and 300 mg aspirin should be chewed (if no contraindications to aspirin)
  • if possible intravenous access should be obtained. This permits administration of analgesia such as diamorphine if available, an antimetic such as metoclopramide, and resuscitation drugs in the case of a cardiac arrest

If hospitalisation is significantly delayed then commencing thrombolysis in the community can be beneficial - the indications for this will be detailed in local guidance.