PROTOCOL NO.

10

CHEST PAIN 
( N O N - T R U A M AT I C )

By Jawad Ahmed (EMD)

 OBJECTIVES:

Defination
Sign & Symptoms
Causes
Some important Rules & Laws & other additional
information about chast pain in MPDS
How to handle an Emergency Call and determine the
appropriate code

DEFINATION OF CHEST PAIN:


Discomfort and soreness in and around the chest

A long-lasting pain in the centre or left side of the chest
(especially if it extends down into the arms and around to the
back and neck) requires medical attention.
 SIGNS & SYMPTOMS:
Aching pain
Chest pain (now gone)
Constriction band
Crushing dis comfort
Heaviness
Numbness
Pressure
Tightness



These symtoms are common in the chest pain and these
 symptoms present in arms,jaw neck or upper back. So if the
caller any time report these symptoms on call so we (EMDs)
should handle it on CHEST PAIN PROTOCOL
 CAUSES:
 Critical Problems:
Dissecting thoracic arotic aneurysm:
 It is generally a swelling\dilation of the arotic artery located in thoracic
 cavity. It has a large risk of rupture which cause sever dissecting pain
 Heart Attack (M.I):
 M.I is commonly known as a heart attack. It is the interruption of blood
supply to a part of the heart,causing heart cells to die



 CAUSES:

 Potentially Critical Problems:

 RULES:

1. A patient having a heart attack may worsen at any

time. Always advice the caller to call back if condition
worsen.
2.A patient > or = to 35 with Chest pain is considered a heart
attack patient untill proven otherwise.
3.If the caller asks whether the patient should be given their
medication now, the EMD should only give
intructions included in the protocol.
4.Chest pain due to trauma (current or non-recent) should
be handled on Protocol 30.
 LAWS:

 First Law of chest pain

 “Hurts to breath” is not considered difficulty or abnormal
breathing.


 Second Law of chest pain

 A little chest pain may be as bad as a lot.
 ADDITONAL INFORMATION:

1.
2.True heart attacks are uncommon in females< 45 and
males< 35.
3.Ambulance Control may consider heart attack (and as ALS
CHARLIE response) in certain patients <35 when the
symptoms listed in Heart Attack Symptoms.
4.Automated external defibrillators (AED) might also be called
“shock boxes.” Other local names may be used.
 KEY QUESTIONS:
 1. Is s/he completly alert?
2. Is s/he breathing normally?

 a.(No) Does s/he difficulty speaking (crying) between breaths?




DIFFICULTY SPEAKING BETWEEN BREATHS
Can also be defined as:

.Unable to complete a complete a full sentence without taking a
 breath

.Only able to speak a few words with out taking a breath
.Breathing attempts that severely hinder crying infant and small

children

3. Is s/he changing colour?
 a.(Yes) Describe the colour change.



CHANGING COLOUR
 Changing colours of clinilcal significance include:
 . Ashen/Grey

 .Blue/Cyanotic/Purpule

 .Mottled

4. Is s/he clammy?

5. Is s/he nauseated or vomiting?

6. Has s/he had a heart attack or angina (heart pains)?

7. Did s/he take any drugs or medication in past 12 hours?

 Cocain (or derivation)


D
1. Not Alert 10-D-1
2. DifficultySpeaking Between Breaths. 10-D-2
3. CHANGING COLOUR. 10-D-3
4. Nausea or Vomiting 10-D-4

C
1 Abnormal Breathing. 10-C-1
2Heart attack or Angina. 10C-2

3Cocain 10-C-3
4Breathing Normally > 35 10-C-4
 A
1. Breathing Normally12-34 10-A-1
2.Breathing Normally < 12 ( drugs or medications taken) 10-A-2

10-Ω-1 Breathing Normally < 12 (no drugs or medications taken) 1.

Ω
 PDI’s:


a. I am organising help for you now. Stay online and i’ll
tell you exactly what to do next.
b.(> or = to1+D-1,2,3) if there is defibillator(AED)

available,send someone to get it now in case we need it

later
c.(Paytient medication requested and alert) Remind

her/him to do what her/his doctor has insturcted for

these situations.

*Stay on the line with caller if her/his condition seems

unstable or is worsening
*Utilise the Aspirin diagnostic & Instruction Tool if th patient
is alert and > or = to 16years old
 ASA ASPIRIN DX
1. (Chest pain and alert >16) Is s/he allergic to aspirin, or ever had a bad


reaction to it before?
 Yes- Do not proceed with aspirin instructions------
2. (No) Has s/he vomited blood or coffee ground material in the last 24

hours?
 Yes- Do not proceed with aspirin intructions------
3. (No) Has s/he passed black or bloody stools in the last 24 hours?

 Yes- Do not proceed with aspirin intructions------

4. (No) Does anyone there have any aspirin available? (Ask them now.)

 No- Do not proceed with aspirin intructions------

5. (Yes) Get one full-dose (300mg) aspirin or four low-dose (75mg)

aspirins and tell me when you have them.

6. (Not obvious) Which type do you have?


* If the caller has a dose other than 300 or 75 mg,or if they are unsure what dose
they have,clarify the exact mg amount an enhance the instructions so the dose


 give to the patient is as close to 300mg as possible


 ADMINISTRATION INSTURUCTION:



(Full-dose apirine-300mg) Tell her/him to chew one full
dose(300mg)aspirine right now

(Low-dose aspirin-75mg) Tell her/him to chew four low-
dose(75mg) asipirin right now

(Unable to chew) Tell her/him to put the aspirin under her/his
toung to dissolve

(Requested to wash down aspirin) Tell her/him that s/he can use
just a mouthful of water to wash it down
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