P Chest pain in the pediatric patient is rarely related to a cardiac event. Assessment of other causes (e.g., muscle pain, respiratory difficulties, injury) should be completed to determine the source of pain. Application of supplemental oxygen and transport should be the mainstay of care for these patients. Contact MCP for further advice when needed.


A An unstable cardiac patient is one who is hypotensive, or has chest pain with poor skin color or diaphoresis.

A A patient with chest pain, moderate distress, who has an oxygen sat of < 94%, should be given oxygen via NC and titrated to 94%.

A A patient with chest pain, minor distress, whose oxygen sats are > 94%, should not get any oxygen.

A No significant change in patient condition in the filed should be expected from the administration of Aspirin. The treatment of active chest pain in appropriate patients should include both Nitroglycerin (after 12-lead EKG) and Aspirin. There is definite, time dependent benefit, to aspirin making field administration of significant value.

A Give Aspirin (ASA) 324 mg to every patient ≥ 25 years of age with symptoms of Acute Coronary Syndrome (ACS) including anginal chest pain, shortness of breath, syncope, diaphoresis, weakness, nausea or vomiting. Some patients (elderly or diabetics) often may have atypical symptoms. Patient MUST CHEW the ASA.

A Ask male and female patients if they have taken Viagra, Cialis, Levitra, Revatio or similar medications within the last 24 hours. Do not administer Nitroglycerin (NTG) if they have taken the above medications. NTG may cause profound hypotension in these patients.

A If SBP >100, and the patient is ≥ 25 y/o, administer Nitroglycerin 0.4 mg SL every 5 minutes for pain, to a total of three pills with vital signs between doses. Prior to NTG administration, establish vascular access for patients who have not previously had NTG.

A Consider Pain Control Protocol, provided SBP >100 after first nitro. DO NOT WAIT UNTIL 3 NITROS ARE GIVEN BEFORE CONSIDERING FENTANYL.

A Prior to moving patient, acquire a supine {12-lead EKG} on all patients with ACS symptoms. Some patients (elderly or diabetics) often may have atypical symptoms.

A {Transmit} EKG with two identifiers, such as name, DOB, Medic number, age and sex to MCP any {12-lead EKG} that meets Cardiac Alert criteria, or any that is questionable.

A The MCP shall be contacted after any {12-lead EKG transmission} is completed.

A Consul MCP for appropriate destination.

A IV fluid, up to 500 ml, may be administered to a patient with SBP < 100 without pulmonary edema. If RVI is suspected with hypotension, consult MCP for fluid bolus.

A Consider repeat {12-lead EKGs} during transport.

NOTE: Revatio is a drug approved for treatment of pulmonary arterial hypertension (PAH), a disease that may be treated with Flolan at end stage. The drug contains Sildenafil which is Viagra. Organic nitrates are contraindicated with Revatio. Revatio is prescribed for both men and women. Providers should ask patients, especially PAH patients, about both Viagra and Revatio before giving NTG.


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