Guidelines speed up triage of AMI patients
These are guidelines from the National Heart Attack Alert Program at the National Heart, Lung, and Blood Institute in Bethesda, MD, for improving emergency department registration and triage of acute myocardial infraction (AMI) patients:
Registration or clerical staff should be instructed that in patients who are more than 30 years old with the following chief complaints require immediate assessment by the triage nurse and should be referred for further evaluation:
• chest pain, pressure, tightness, heaviness, or radiating pain in the neck, jaw, shoulders, back, or one or both arms;
• indigestion or "heartburn," nausea, and/or vomiting;
• persistent shortness of breath;
• weakness, dizziness, lightheadedness, or loss of consciousness.
The triage nurse should assess patients with the following symptoms for initiating the AMI protocol in patients more than 30 years old:
• chest pain or severe epigastric pain, nontraumatic in origin, having components typical of myocardial ischemia or infarction, as follows:
central/substernal compression or crushing chest pain;
pressure, tightness, heaviness, cramping, burning, aching sensation;
unexplained indigestion or belching;
radiating pain in the neck, jaw, shoulders, back, or one or both arms;
• associated dyspnea;
• associated nausea/vomiting;
• associated diaphoresis.
If any of those symptoms are present, obtain a stat electrocardiogram.
The triage nurse should do a brief, targeted, initial history assessing the patient for current or past history of the following:
• coronary artery bypass graft, angioplasty, coronary artery disease, or AMI;
• nitroglycerin use to relieve pain;
• risk factors, including smoking, hyperlipidemia, hypertension, diabetes mellitus, family history, or cocaine use.
The brief history should not delay the patient’s entry into the AMI protocol.
Be aware of atypical chest pain and symptoms in female patients. Diabetic patients may have atypical presentations due to autonomic dysfunction. Elderly patients may have stroke, syncope, or change in mental status.
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