pre-hospital management

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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.

Last edited 12/2020 and last reviewed 12/2020

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