What should I do if I'm experiencing severe symptoms or a medical emergency?

Emergency Response for Severe Symptoms or Medical Emergency

If you are experiencing severe symptoms or a medical emergency, call 9-1-1 immediately and do not delay beyond 5 minutes of unimproved or worsening symptoms. 1

Immediate Actions You Must Take

Call 9-1-1 if any of the following are present:

• Chest pain or discomfort lasting more than 20 minutes at rest 1
• Severe shortness of breath (dyspnea) 1
• Recent syncope (fainting) or feeling like you're about to faint (presyncope) 1
• Hemodynamic instability (feeling lightheaded, cold/clammy skin, confusion) 1
• Severe palpitations (rapid or irregular heartbeat) 1
• Persistent fever with severe vomiting or dehydration 2
• Frank blood in stools with abdominal distension 2

Critical Time Window

Do not wait more than 5 minutes if symptoms are unimproved or worsening before calling 9-1-1. 1 Mortality from acute coronary syndrome and other life-threatening conditions increases significantly with treatment delays. 1 This is not a time for telephone consultation with your doctor—you need facility-based evaluation with ECG and biomarkers. 1

What NOT to Do

• Do not drive yourself to the hospital 2
• Do not have someone else drive you 2
• Do not attempt to self-treat with over-the-counter medications and wait to see if symptoms improve 2
• Do not delay calling 9-1-1 to contact your primary care physician first 1

If You Have Nitroglycerin Prescribed

If you have chest discomfort and have been previously prescribed nitroglycerin:

• Take 1 dose of nitroglycerin immediately 2
• If chest discomfort is unimproved or worsening 5 minutes after taking 1 nitroglycerin sublingually, call 9-1-1 immediately 2
• Do not wait to take all 3 doses before calling for help 2

Why Emergency Medical Services (EMS) Transport Is Critical

Patients transported by ambulance receive:

• Immediate cardiac monitoring and access to defibrillation if needed 2
• Pre-hospital ECG that can be transmitted to the hospital, reducing treatment delays 2
• Immediate access to emergency resuscitation equipment 2
• Direct transport to the most appropriate facility (e.g., hospitals with interventional capability for heart attacks) 2

Approximately 1.5% of patients with chest pain transported by EMS develop cardiopulmonary arrest before arrival at the hospital or in the emergency department. 2 Having trained personnel and equipment immediately available can be lifesaving.

For Non-Cardiac Emergencies

Seek medical advice within 48 hours if:

• No improvement is seen in gastrointestinal symptoms after 48 hours 2
• Symptoms exacerbate or overall condition gets worse 2

However, seek immediate emergency care if warning signs develop such as severe vomiting, dehydration, persistent fever, abdominal distension, or frank blood in stools. 2

Family Member Instructions

If you are a family member, close friend, or caregiver of someone at risk for cardiac events:

• You should be explicitly instructed on when to call 9-1-1 1
• Help ensure rapid action when symptoms worsen 1
• Do not allow the patient to delay seeking emergency care 1

What Happens in the Emergency Department

Upon arrival, you should expect:

• Placement on continuous cardiac monitoring with emergency resuscitation equipment and defibrillator immediately available 2
• 12-lead ECG performed within 10 minutes of arrival 2, 1
• Evaluation by an experienced emergency medicine physician within 10 minutes 2
• Immediate cardiology consultation if diagnosis is unclear or high-risk features are present 2