Chest pain protocol Karen Jennings, RN

Introduction When a hospitalized patient experiences chest pain, there is an immediate protocol that goes into effect. This protocol consists of step by step actions to be taken to diagnose and treat the patient as quickly and efficiently as possible in order to save heart muscle and prevent possible death.

Evidence based practice A chest pain algorithm is in place in the hospital to help identify patients that may be experiencing a heart attack. Protocols of this nature have been shown to save lives and decrease the amount of damage done to the heart (www.acls.net). When a patient experiences chest pain, the first thing to do is obtain a stat 12 lead EKG. Vital signs are taken and airway, breathing and circulation are assessed. Determine if patient is experiencing MI or Unstable Angina. If patient is unstable, the Rapid Response Team is called. Patient will receive Morphine, Nitroglycerin, and oxygen if needed. If the patient arrests during the Rapid Response, CPR is started (www.heart.org).

technology 12 Lead EKG, Bedside Cardiac Monitor with Vital Signs, Defibrillator, Radiograph of Chest

Swift action is needed. Most of the technologies do not communicate with each other.

Be the strong link Know the steps to take to save lives! The nurse will access the technology by bringing the “crash cart” to the bedside. If the patient is not already on a bedside cardiac monitor, they will be hooked up and vital signs assessed. The EKG tech is called to the bedside for that assessment. There are also alarms in the patient’s room if the nurse needs help from the Rapid Response Team. Radiology is called to the bedside if chest xray is needed. Blood specimens are drawn and assessed in the lab.

Communicate clearly The only gaps in this protocol would come from inexperience or lack of proper communication among the staff. However, typically, several nurses, techs and management rush to the bedside to assist in any way possible.

summary To summarize the information in this presentation, it is a way of bringing several disciplines together to achieve the same goal which is the diagnosis and treatment of cardiac related issues. Protocols need to be very clear and concise and practiced regularly. Practice is in the form of “mock codes” done without notice on the various units in the hospital with educators present.

feedback There is always a debriefing after a Rapid Response or Code Blue situation. We always appoint a timekeeper to document everything done and the timetable of events. This is reviewed along with actions taken by all team members and the outcome of the patient. This is to learn what went right and also what can be improved on. Unit managers, among others, are present at these debriefings.

References https://www.acls.net/acute-coronary-syndromes-algorithm.htm http://www.heart.org/HEARTORG/CPRAndECC/CPR_UCM_001118_SubHomePage.jsp