Sandbox Rim

Assess the ECG

Does the patient have ANY of the following? ❑ ST elevation ❑ ST depression ❑ New LBBB

Yes

No

Does the patient have any of the following?

Rule out the following life-threatening conditions

❑ ST elevation in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads, OR ❑ ST depression in at least two precordial leads V1-V4 (suggestive of posterior MI), OR ❑ ST depression in several leads plus ST elevation in lead aVR (suggestive of occlusion of the left main or proximal LAD artery), OR ❑ New LBBB AND ❑ PR depression is absent

❑ ST depression in at least two precordial leads that fits the anatomic distribution of a coronary artery (not V1 through V4)

❑ Diffuse ST elevation, AND/OR ❑ PR depression, AND/OR ❑ PR elevation in lead aVR

C01= STEMI

Pericarditis

Unstable angina/NSTEMI

Aortic dissection

Pulmonary embolism

Tension pneumothorax

Esophageal rupture

Activate the cath lab team Look for supportive signs and symptoms while the cath lab team is mobilized: ❑ Pain described as a heaviness or crushing sensation ❑ Pain radiating to the left arm ❑ Dyspnea ❑ Nausea and vomiting ❑ Diaphoresis ❑ High troponin ❑ High CK MB

Activate the cath lab team Look for supportive signs and symptoms while the cath lab team is mobilized: ❑ Pain described as a heaviness or crushing sensation ❑ Pain radiating to the left arm ❑ Dyspnea ❑ Nausea and vomiting ❑ Diaphoresis ❑ High troponin ❑ High CK MB

Look for supportive signs and symptoms: ❑ Pleuritic pain ❑ Chest pain that is positional ❑ Viral syndromes ❑ Fever ❑ Cough ❑ Pericardial rub

Look for supportive signs and symptoms: ❑ Sudden onset of chest pain radiated to the back or interscapular pain ❑ Back pain ❑ Acute heart failure ❑ Low pitched early diastolic murmur best heard at the 2nd right intercostal space ❑ Asymmetric blood pressure in the upper extremities ❑ Coma ❑ Diminution or absence of pulse ❑ Altered mental status ❑ Vagal episode ❑ Evidence of ischemia ❑ Splanchnic ischemia ❑ Renal insufficiency ❑ Lower extremity ischemia ❑ Focal neurologic deficits

Look for supportive signs and symptoms: ❑ Pleuritic chest pain ❑ Dyspnea ❑ Anxiety ❑ History of: ❑ DVT ❑ Recent surgery ❑ Malignancy ❑ Immobility

Look for supportive signs and symptoms: ❑ Sudden Shortness of breath ❑ Cyanosis ❑ Penetrating chest wound ❑ Flopping sound ❑ Recent medical procedure ❑ Patient on mechanical ventilation ❑ Tracheal deviation towards the unaffected side ❑ Absent heart sound on the affected side ❑ Hyperresonance on the affected side

Look for supportive signs and symptoms: ❑ Vomiting ❑ Lower chest pain ❑ Hematemesis ❑ Cervical subcutaneous emphysema ❑ Overindulgence in alcohol ❑ Overindulgence in food

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Click here for the detailed management

Click here for the detailed management

Click here for the detailed management

Click here for the detailed management