Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute onset of substernal chest pressure radiating to the left jaw and arm, associated with diaphoresis, nausea, and dyspnea. Symptoms began [Time] ago, constant in nature, rated [Scale]/10 in severity. No prior history of similar symptoms.
Clinical Examination Findings
General: Patient appears in acute distress, diaphoretic, and pale. Cardiovascular: Tachycardic, regular rhythm, S1/S2 present, no murmurs, rubs, or gallops. Lungs: Clear to auscultation bilaterally, no crackles or wheezes. Extremities: No peripheral edema, pulses 2+ bilaterally.
Treatment Protocol
Immediate management initiated: Aspirin 325mg chewed, P2Y12 inhibitor (loading dose), IV Heparin bolus, and Nitroglycerin SL as tolerated. Patient prepared for emergent cardiac catheterization/PCI. Oxygen titrated to maintain SpO2 >94%.