✅Attend patient STAT.
✅ to look for DDX/life threatening condition. E.g. ACS, PE, pneumothorax, aortic dissection, acute HF, cardiac arrest

✅ assess the patient's well-being and look at the vital signs to ensure whether the patient is stable or not, conscious or not. Vital signs (BP, PR, RR, T, pain score)

In concious patient:
✅ proceed asking further history (SOCRATES) about the chest pain. And apply ECG.

Socrates:
Site: central, retrosternal pain

Onset: sudden or progressive. Any previous episode of chest pain?

Character: pressing, squeezing, heaviness, tearing pain

Radiation: to the left arm, jaws

Associated sx: profuse sweating, palpitation, NnV, dyspnoea, syncope, calf pain

Time

Exacerbating/releaving factors: exertional pain, worsen upon lying/respiration. Relieved by leaning forward, rest

Score: pain score


✅ quick physical examination
🫀 cardiovascular examination
-CABG scar, implantable defibrillator
- auscultation: murmur, gallop rhythm
- look for signs of HF

🫁 lung examination
- breath sounds ( absent/reduced: pneumothorax), additional lung sounds ( crep, rhonchi)

Abdomen: AAA

✅ IX
📌 ECG stat ( identify STEMI, any cardiac causes)
📌 take cardiac biomarkers (troponin, CKMB) if suggestive of ACS
📌 order CXR if we suspect lung causes

✅Mx
📌secure ABC
AIRWAY & BREATHING: give O2 supplimentation if spo2 <95%
CIRCULATION : blood ix as above and trace. Must have IV access.

📌 Medications:
- if STEMI s/l GTN 0.5mg STAT, if pain not resolve repeat up to 3x. Can give if SBP >90mmHg, inferior MI and aortic dissection have been excluded. Aspirin and clopidogrel STAT.
- if fluid overload ( sign and sx of congested) give frusemide

If pneumothorax, call for help. Ready with equipment. If tension pneumothorax( needle thoracocentesis - temporary measure, chest tube-definitive)


However, I need to call MO and discuss mx before executing the plans.

If unconscious pt:
- check pulse and breathing if absent call for help and start ACLS.
-Identify either it is a shockable rhythm or unshockable rhythm
-if shockable ( VF/pVT)
- non shockable (asystole/PEA)

Shockable rhythm ▶️ give shock ▶️ CPR 2 min (+ IV access) ▶️ still shockable rhythm give shock ▶️ CPR 2 min, epinephrine every alternate cycle ▶️ still shockable rhythm, give shock ▶️ CPR 2 min, amiodarone, treat reversible cause

Non shockable rhythm ▶️ CPR 2 min, epinephrine every alternate cycle ▶️ still non shockable rhythm, CPR 2 min. If shockable ▶️ follow shockable rhythm algorithm