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Is the first spray of nitro before or after initiating transport?

Before

Indications for chest pain protocol

Presentation suggests cardiac, Hx of heart disease, and would take Rx nitro...

OR...presentation suggests cardiac but no Rx nitro because this is 1st episode (skip nitro step).

Contraindications for ASA

Inability to swallow
Allergy to ASA
Active peptic ulcer or GI bleed
Pediatric pt

Contraindications for nitro

BP 100 or worse
Viagra within 24hr
Levitra within 24hr
Cialis within 48 hr

What to check before each spray of nitro

Pain scale and BP

Dosage/route/frequency of nitro

0.4 mg SL q5min x up to 3 doses

Dosage/route/frequency of ASA

160-162 mg PO (chewable) including their own, once following 1st nitro.

If pain persists after 3 doses nitro (or contraindicated nitro), how do you proceed?

Entonox PRN 5 min post-nitro. Nitro x 3 may be restarted 30 min after first dose of nitro. Stop Entonox 5 min prior to nitro.

Chest pain is completely relieved for more than 5 min, but then returns. What now?

Restart nitro x up to 3 doses (or Entonox if nitro contraindicated).

When do you transport during the chest pain protocol?

Ideally after the 1st spray of nitro, but before ASA administration.

Any extra things to do in the primary during the chest pain protocol?

History including meds, allergies, med conditions, rule in cardiac issue, rule out contraindications, and pain scale.

Summary of chest pain protocol:

Nitro, transport, ASA, nitro?, nitro?, Entonox?, nitro? etc

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