Medical Emergencies: Recognition and Initial Treatment

Medical Emergencies: Recognition and Initial Treatment

1. Chest Pain

Somewhere in the heart, a coronary artery narrows or clots off. The muscle downstream of that blockage stops getting enough oxygen. So it starts to die. That's ischemia, and it's what's underneath every case of chest pain you have to treat as cardiac.

You're not going to diagnose it in the field. There's no EKG interpretation, no troponin, in your scope. So the rule is simple. Any chest pain is cardiac until the hospital proves otherwise.

Cardiac pain tends to look a certain way, and noncardiac pain tends to look a different way. Here's the split:

Age over 50, male, diabetes, hypertension, smoking, and a personal history of heart disease all raise your suspicion. But don't lean on that list too hard. Women, older adults, and diabetics often present atypically — jaw pain, nausea alone, unexplained weakness, sometimes no chest pain at all. The National Registry tests that atypical presentation specifically, because it's the case where a student's gut says "probably not cardiac" and the gut is wrong.

You can't rule cardiac out with a reproducible, sharp, localized pain either — you can only get suspicious. The clinching move is never in your hands. It's an EKG and a blood draw at the hospital. Your job is oxygen as indicated, position of comfort, monitor, and transport.

Treating chest pain

The EMT scope names three medications for a cardiac patient: aspirin, nitroglycerin, and oxygen. All three come with protocol conditions attached.

1. Position of comfort — usually sitting upright — and keep the patient at rest. Don't let them walk.
2. Oxygen only if SpO₂ is below 94% or the patient is in respiratory distress. Routine high-flow oxygen on every chest pain patient is outdated, and it's a common wrong answer on the exam.
3. Aspirin, chewed, not swallowed whole, if the patient is alert, can swallow, and has no allergy or contraindication. The usual dose is 160–325 mg — commonly four 81 mg chewable tablets — per your protocol. Chewing is what makes the absorption fast enough to matter.
4. Nitroglycerin, sublingual, only the patient's own prescription, only per protocol. Take a blood pressure before and after every dose. Hold it below the systolic threshold your protocol sets — commonly 100 mmHg. And hold it entirely if the patient has taken an erectile-dysfunction medication within the window your protocol specifies. That combination drops the blood pressure hard.
5. Reassess vitals every 5 minutes and watch for deterioration.
6. Transport to a hospital with cardiac catheterization capability, and notify them early.