Sandbox Rim

Assess the ECG

Does the patient have ANY of the following? ❑ ST elevation ❑ ST depression ❑ New LBBB

Yes

No

Does the patient have any of the following?

Rule out the following life-threatening conditions

❑ ST elevation in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads OR ❑ ST depression in at least two precordial leads V1-V4 (suggestive of posterior MI) OR ❑ ST depression in several leads plus ST elevation in lead aVR (suggestive of occlusion of the left main or proximal LAD artery) OR ❑ New LBBB AND ❑ PR depression is absent

❑ ST depression in at least two precordial leads that fits the anatomic distribution of a coronary artery (not V1 through V4)

❑ Diffuse ST elevation, AND/OR ❑ PR depression, AND/OR ❑ PR elevation in lead aVR

STEMI

NSTEMI

Pericarditis

Aortic dissection

Pulmonary embolism

Tension pneumothorax

Esophageal rupture

Activate the cath lab team while the cath lab team is mobilized Look for supportive signs and symptoms: ❑ Pain described as a heaviness or crushing sensation ❑ Pain radiating to the left arm ❑ Dyspnea ❑ Nausea and vomiting ❑ Diaphoresis ❑ High troponin ❑ High CK MB

Activate the cath lab team while the cath lab team is mobilized Look for supportive signs and symptoms: ❑ Pain described as a heaviness or crushing sensation ❑ Pain radiating to the left arm ❑ Dyspnea ❑ Nausea and vomiting ❑ Diaphoresis ❑ High troponin ❑ High CK MB

Look for supportive signs and symptoms: ❑ Pleuritic pain ❑ Chest pain that is positional ❑ Viral syndrome ❑ Fever ❑ Cough ❑ Pericardial rub

Look for supportive signs and symptoms: ❑ Sudden onset of chest pain radiated to the back or interscapular pain ❑ Back pain ❑ Acute onset of heart failure ❑ Low pitched early diastolic murmur best heard at the 2nd right intercostal space ❑ Asymmetric blood pressure in the upper extremities ❑ Coma ❑ Diminution or absence of pulse ❑ Altered mental status ❑ CVA ❑ Vagal episode ❑ Evidence of ischemia ❑ Splanchnic ischemia ❑ Renal insufficiency ❑ Lower extremity ischemia ❑ Focal neurologic deficits

Look for supportive signs and symptoms: ❑ Pleuritic chest pain ❑ Dyspnea ❑ Anxiety ❑ History of: ❑ DVT ❑ Recent surgery ❑ Malignancy ❑ Immobility

Look for supportive signs and symptoms: ❑ Sudden shortness of breath ❑ Cyanosis ❑ Penetrating chest wound ❑ Flopping sound ❑ Recent medical procedure ❑ Patient on mechanical ventilation ❑ Tracheal deviation towards the unaffected side ❑ Absent heart sound on the affected side ❑ Hyperresonance on the affected side

Look for supportive signs and symptoms: ❑ Vomiting ❑ Lower chest pain ❑ Hematemesis ❑ Cervical subcutaneous emphysema ❑ Overindulgence in alcohol ❑ Overindulgence in food

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Click here for the detailed management

Click here for the detailed management

Click here for the detailed management

Click here for the detailed management

Click here for the detailed management

Click here for the detailed management