What are the immediate recommendations for someone experiencing chest pain with breathing difficulties?

Immediate Recommendations for Chest Pain with Breathing Difficulties

For anyone experiencing chest pain with breathing difficulties, immediately call emergency medical services (EMS) rather than attempting to transport the person to a healthcare facility yourself. 1

Initial Assessment and Actions

Step 1: Call EMS

• Activate emergency response system immediately for anyone with chest pain and breathing difficulties 1
• While waiting for EMS, keep the person in a comfortable position

Step 2: Assess for Cardiac Causes

• If signs suggest a heart attack (chest pressure, shortness of breath, nausea, sweating, pain in jaw/arm/back), consider aspirin administration 1
• For suspected heart attack, encourage the person to chew and swallow aspirin (162-325 mg) while waiting for EMS, unless they have:
  • Known aspirin allergy
  • Recent bleeding
  • Been advised by a healthcare professional not to take aspirin 1
• If uncertain about cardiac origin, do not administer aspirin 1

Step 3: Position the Person Appropriately

• If the person shows signs of shock but has no trauma/injury, place them in a supine position 1
• Consider raising feet 6-12 inches if no trauma and no pain with movement 1
• Do not raise feet if movement causes pain 1

Step 4: Assist with Breathing

• For a person with asthma having difficulty breathing, assist with prescribed bronchodilator administration if available 1
• For those with carbon monoxide exposure, supplementary oxygen may be reasonable if available and provider has specific training 1

Recognizing Different Causes of Chest Pain with Breathing Difficulties

Potential Cardiac Causes

• Acute Coronary Syndrome: Diaphoresis, tachypnea, tachycardia may be present; exam may be normal in uncomplicated cases 1
• Look for: Chest pain/pressure, shortness of breath, nausea, sweating, pain in jaw/arm/back 1

Potential Pulmonary Causes

• Pulmonary Embolism: Tachycardia + dyspnea in >90% of patients; pain with inspiration 1
• Pneumothorax: Unilateral decreased/absent breath sounds, dyspnea and pain on inspiration 1
• Pneumonia: Fever, localized chest pain (may be pleuritic), regional dullness to percussion 1

Other Serious Causes

• Aortic Dissection: Severe pain with abrupt onset, pulse differential, described as "worst pain of life" 1
• Pericarditis: Fever, pleuritic chest pain worse in supine position, friction rub 1

Common Pitfalls to Avoid

• Do not delay EMS activation - approximately 1 in 300 patients with chest pain transported by private vehicle experience cardiac arrest en route 1
• Do not rely on nitroglycerin response as a diagnostic criterion for myocardial ischemia 1
• Do not dismiss atypical presentations - women, elderly patients, and those with diabetes may present with atypical symptoms like throat or abdominal discomfort 1
• Do not fail to obtain serial assessments in patients with persistent symptoms 2
• Do not raise the feet of a person in shock if movement causes pain 1

Special Considerations

• For women with chest pain, consider that accompanying symptoms may differ from classic presentations 1
• For patients over 75 years, consider ACS when accompanying symptoms like shortness of breath, syncope, or acute delirium are present 1
• For patients with known asthma having breathing difficulties, assist with prescribed bronchodilator administration 1

Remember that early recognition and prompt EMS activation are critical factors in reducing mortality for patients experiencing chest pain with breathing difficulties.