What are the immediate steps for a male with severe chest pain?

Immediate Management of Male with Severe Chest Pain

Call 9-1-1 immediately to activate EMS for transport to the nearest emergency department—this is the single most critical action that reduces mortality and treatment delays. 1

First Priority: Activate Emergency Medical Services

• Activate the emergency response system (call 9-1-1) immediately rather than attempting private vehicle transport, as EMS transportation substantially reduces ischemic time and treatment delays compared to personal vehicle transport. 1
• Approximately 1 in 300 patients with chest pain transported by private vehicle experiences cardiac arrest en route, making EMS transport essential for safety. 1, 2
• The patient should remain at rest while awaiting EMS arrival to minimize myocardial oxygen demand. 3, 4

Second Priority: Aspirin Administration While Awaiting EMS

While waiting for EMS arrival, encourage the alert patient to chew and swallow aspirin 162-325 mg unless contraindicated. 1

Aspirin Administration Guidelines:

• The patient should chew the aspirin (not swallow whole) for faster absorption—either one adult 325-mg tablet or 2-4 low-dose 81-mg tablets. 1
• Early aspirin administration (within the first few hours) reduces mortality in myocardial infarction compared to delayed administration. 1
• Do NOT give aspirin if the patient has a known aspirin allergy, recent bleeding, or has been advised by a healthcare professional not to take aspirin. 1
• If there is any uncertainty about whether aspirin should be given, wait for EMS arrival without administering aspirin—defer this decision to EMS providers with physician oversight. 1

Third Priority: Patient Positioning and Monitoring

• Have the patient sit or lie down to prevent falls from potential lightheadedness or syncope. 5
• Keep the patient calm and minimize physical exertion while awaiting EMS. 3, 4
• If the patient has been previously prescribed nitroglycerin and has it available, they may take one dose sublingually. 1, 5
• However, if chest pain is unimproved or worsening 5 minutes after one nitroglycerin dose, call 9-1-1 immediately (or ensure it has already been called). 1

Critical Pitfalls to Avoid

Do Not Delay EMS Activation:

• Never delay calling 9-1-1 to self-medicate with aspirin or nitroglycerin first—the priority is activating EMS, which can then provide aspirin en route or upon arrival. 1
• Do not wait to see if symptoms resolve on their own, as individuals with chest pain often delay seeking care, leading to poor outcomes. 1

Do Not Rely on Symptom Severity:

• Pain severity is a poor predictor of imminent complications such as cardiac arrest—even mild chest discomfort can represent acute myocardial infarction. 3, 4
• The physical examination contributes almost nothing to diagnosing myocardial infarction unless shock is present, so do not be falsely reassured by normal vital signs or appearance. 3

Recognize Atypical Presentations:

• Be aware that chest pain may not be "dramatic" as portrayed in media—it can be subtle pressure, discomfort, or squeezing. 1
• Associated symptoms may include shortness of breath, cold sweat, nausea, vomiting, lightheadedness, or pain radiating to the jaw, arm(s), or back. 1
• Elderly patients, those with diabetes, and women may present with atypical symptoms despite severe disease. 3, 2, 4

What NOT to Do

• Do not administer oxygen unless the patient is hypoxic—oxygen is not recommended for acute coronary syndromes in non-hypoxic patients. 1
• Do not transport the patient yourself to the hospital—use EMS for reasons outlined above. 1, 2
• Do not give someone else's nitroglycerin to a patient who has not been prescribed it. 1
• Do not give aspirin if contraindicated (allergy, bleeding risk, or medical advice against it). 1

Upon EMS Arrival

EMS personnel will:

• Place the patient on a cardiac monitor with resuscitation equipment available. 3, 2
• Obtain a 12-lead ECG within 10 minutes to identify ST-elevation myocardial infarction or other acute changes. 3, 2, 4
• Establish IV access and administer additional medications as needed. 2
• Transport to the appropriate facility, with STEMI patients going directly to hospitals with interventional capability. 4