Assess AMI Stat
Instruct registration and clerical nurses that patients over age 30 who have the following chief complaints require immediate acute myocardial infarction (AMI) assessment by the triage nurse and should be referred for further evaluation:
- chest pain described as pressure, tightness or 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.
(See AMI protocol, p. 5.) The triage nurse should assess patients with 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;
- 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. Perform 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.
Source: National Heart, Lung, and Blood Institute, Bethesda, MD.
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